summary: Facility Evaluation

raw_content:
Narrative:
On March 12th, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Ruth and Jacob Small Family Home (SFH) to conduct pre-licensing inspection for an initial license. LPA met with applicants Ruth and Jacob who led a tour of the entire home. The applicants are applying for a capacity of 4 children, 3 ambulatory and 1 non-ambulatory, ages 0-17 years old . The home is a two-story building with six bedrooms and 3 bathrooms. The downstairs consisted of living room #1 that had couches, a piano, and a dining table that had adequate seating. Bedroom #1 was downstairs and had two full size beds with closet and dresser space that would be utilized for two foster children and was currently vacant. There was bathroom #1 that was fully functioning with a walk in shower with water temperature reaching 107.6 degrees F. There was bedroom #2 that was a non- ambulatory room with two exit ways. One door was leading to the outside with a ramp and the other door was leading to the indoor entry way. There was a hallway with a fire extinguisher and all required postings such as visitation policy, emergency disaster plan, and personal rights. There was another hallway that stored client/ staff files in two separated locked boxes inside a locked cabinet, there was another locked cabinet that stored a locked box for client medication, a locked box for client cash resources and a first aid kit with all required elements. There was living room #2 that had couches, TV, a fireplace that was properly screened, and board games/ game consoles. The kitchen had a refrigerator and pantry with plenty of perishable and non-perishable foods. A proper storage of all food was discussed. The knives and sharp objects were locked in a cabinet. The kitchen sink had dish cleaning items locked and stored under it. The laundry room was also located downstairs and was accessible to clients with a locked cabinet storing laundry detergents and cleaning supplies. The garage stored extra household items, a refrigerator, and deep freezer with extra foods. The applicants were advised to supervise foster children when in the garage. The upstairs consisted of a study area with a desk and computers. There was bedroom #3 that was for applicants biological son and one foster child. There was two full size beds with proper bedding and storage space for 1 foster child and applicants biological son. There was bedroom #4 that had two full size beds for 1 foster child and applicants biological daughter. There was adequate closet/ drawer space as well as lighting. Applicants understand that foster children are to share a room with those in the same age range as well as same sex. Bathroom #2 was located upstairs and had two fully functioning sinks, a toilet, and shower/tub. There was one locked cabinet storing bathroom cleaning supplies and another cabinet storing extra hair products. Bedroom #5 had a full size bed and was occupied by applicants eldest biological son. The hallway stored extra blankets, linen, and towels. There was bedroom #6 that was a master bedroom for applicants that had bathroom #3 with locked cabinets storing medication and cleaning supplies. The backyard was free of hazards and had two exit gates on both side yards. There was also a storage shed storing sharp gardening tools. There was no pool or other body of water at this time. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closets for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. All trash cans for storage of solid waste had tight fitting lids. LPA observed there to be no land line service. All hazardous items have been properly made inaccessible to areas where clients/children will have access. There are no firearms in the home as stated by applicants. Based on this inspection of the home, the facility will need the following corrections: - Obtain a telephone for land line service After corrections are completed, the applicant will notify LPA so that we can move forward with licensure. Component III orientation was also completed this day of March 12, 2025. An exit interview was conducted. A copy of this report was provided to applicants Ruth and Jacob Munzaa.


state: CA

facility_name: RUTH AND JACOB SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On August 8, 2025, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to Ruth and Jacob Small Family Home (SFH) for a post-licensing inspection. LPA met with licensees Ruth and Jacob Munzaa who led a tour of the entire home. The home was approved for a capacity of four children (three ambulatory and one non-ambulatory) ages 0-17 years old. Currently there are two clients in care. The home is a two-story building with six bedrooms and three bathrooms. The downstairs consisted of living room #1 that had couches, a piano, and a dining table that had adequate seating. Bedroom #1 was downstairs and had two full size beds with closet and dresser space that was occupied by one client. There was bathroom #1 that was fully functioning with a walk in shower. There was bedroom #2 that had a full size bed, dresser/closet space and was occupied by one client. There was a hallway with a fire extinguisher and all required postings such as visitation policy, emergency disaster plan, and personal rights. There was another hallway that stored client/ staff files inside a locked cabinet, there was another locked cabinet that stored client medication, a locked box for client cash resources and a first aid kit with all required elements. There was living room #2 that had couches, TV, a fireplace that was properly screened, and board games/ game consoles. The kitchen had a refrigerator and pantry with plenty of perishable and non-perishable foods. The knives and sharp objects were locked in a cabinet. The kitchen sink had dish cleaning items locked and stored under it. The laundry room was also located downstairs and was accessible to clients with a locked cabinet storing laundry detergents and cleaning supplies. The upstairs consisted of a study area with a desk and computers. There was bedroom #3 that was for licensees biological son and one foster child that had two full size beds with proper bedding and storage space. There was bedroom #4 that had one full size beds for licensees biological daughter. There was adequate closet/ drawer space as well as lighting. Bathroom #2 was located upstairs and had two fully functioning sinks, a toilet, and shower/tub. There was one locked cabinet storing bathroom cleaning supplies and another cabinet storing extra hair products. Bedroom #5 had a full size bed and was occupied by licensees biological son. The hallway stored extra blankets, linen, and towels. There was bedroom #6 that was a master bedroom for licensees that had bathroom #3 with locked cabinets storing medication and cleaning supplies. The backyard was free of hazards and had two exit gates on both side yards. There was also a storage shed storing sharp gardening tools. There was no pool or other body of water at this time. The garage was free of hazards. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closets for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances and telephone land-line service were in working order. All trash cans for storage of solid waste had tight fitting lids. All hazardous items have been properly made inaccessible to areas where clients/children will have access. First Aid kit was accessible with all required items. As stated by licensees, there were no weapons/firearms in the home. Two client files and two personnel files were reviewed as well as both licensees, one resident, and two clients were interviewed. An exit interview was conducted and a copy of this report and two technical assistances were discussed and provided to licensees Ruth and Jacob Munzaa.

report_type: Facility Evaluation

met_with: Licensee- Ruth Munzaa


facility_name: R&E LOVING CARE HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On September 30, Licensing Program Analyst (LPA) Maryjane Perez met with applicant Rhonda Epps this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Rhonda Epps.

met_with: Applicant- Rhonda Epps


summary: Facility Evaluation

raw_content:
Narrative:
On October 10, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at R&E Loving Care Homes Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Rhonda Epps who led a tour of the entire home inside and out. Currently there are no children placed in the home. The applicant is applying to serve five ambulatory children ages 0 to 17 years old. The home is a two-story building with five bedrooms and five bathrooms. The downstairs consisted of an entry way with facility sketch, emergency disaster plan, visitation policy, personal rights posted and fire extinguisher #1 that was operable. There was an office that had a desk and a locked file cabinet for storing client files and employee files. The kitchen had a locked sink cabinet storing sharps/ knives and cleaning supplies. There was a fully stocked refrigerator and pantry with perishable and non-perishable foods, a locked mini refrigerator for storing refrigerated medications. There was a menu posted and a dining table with adequate seating. The living room was fully furnished with a couch, TV, toys, a screened fireplace and a telephone land- line. There was a locked storage closet in the hallway that stored clients medication and a first aid kit with all required elements. Bathroom #1 was fully functioning with hot water temperature measuring 106 degrees Fahrenheit. There was another hallway closet that was locked at all times and stored extra household items. Bedroom #1 was utilized for one client and had a queen size bed, closet/ dresser space, lighting, and bathroom #2 that was fully functioning. The bedroom was currently vacant. The upstairs consisted of a loft with couches, TV, and gaming console for client use. Fire extinguisher #2 and another facility sketch were also posted in the loft. Bedroom #2 was utilized for one client and was fully furnished with a queen size bed, closet/ dresser space, lighting, and bathroom #3 that was fully functioning. The bedroom was currently vacant. There was a hallway closet that stored extra blankets and linens. Bedroom #3 was the master bedroom that was for applicant and will be locked at all times with a queen size bed, closet/ dresser space, and bathroom #4 that was fully functioning. Bedroom #4 was utilized for two foster children but only had one queen size bed, closet/ dresser space and was currently vacant. Applicant understands that clients cannot share a bed therefore, two beds are required in the room to sleep two foster children. The bedroom is currently vacant. The laundry room was accessible to clients with a locked cabinet storing laundry detergents and laundry essentials. Bedroom #5 was utilized for one client and applicants nephew. The bedroom was fully furnished with two twin size beds (one vacant and one occupied) , closet/ dresser space, all required bedding, toys, and adequate lighting. Bathroom #5 had dual sinks with a shower/ bath tub, toilet, and trash can with tight fitting lid. The garage was free of hazards and stored extra household items and had an extra refrigerator. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. All appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. Based on this inspection of the home, the facility will need the following corrections: Two twin size beds in one of the bedrooms in order to sleep two clients Request for a capacity decrease on LIC After corrections are completed, the applicant will notify LPA so another inspection can be completed and the request for licensure can be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of October 10, 2025. An exit interview was conducted. A copy of this report was provided to applicant Rhonda Epps.

visit_type: Prelicensing


facility_name: SAFE AND SOUND SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On December 4, 2023, Community Care Licensing (CCL) received a complaint alleging that the Licensee did not prevent inappropriate interactions between client and another child in the home. During the investigation there was no corroborating evidence to support the allegation. Although it was reported to CCL that there was an incident in the home of inappropriate touching in care involving C1 and a child in the home. The Investigator received inconsistent statements that supported a violation of lack of supervision resulting in the sexually inappropriate interaction between C1 and a child in the home. Confidential interviews denied observing inappropriate sexual behaviors between C1 and a child in the home. Other confidential interviews stated that the sexual interaction occurred without the knowledge of the Licensee and when the information was revealed the Licensee requested the removal of C1. There were no other known witnesses to the allegation. C1 could not be reached for comment regarding the allegation. Based on confidential interviews, and record review the allegation that Licensee did not prevent inappropriate interactions between client and another child in the home, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report along with the appeal rights was provided to Licensee, Destiny Phillip.

Investigation Findings:
13On March 21, 2024, at 9: AM, Licensing Program Analyst (LPA), Cynthia Urena met Safe and Sound Small Family Home (SFH) Licensee, Destiny Phillip to deliver the investigative finding for the above stated allegation. On December 13, 2023, Licensing Program Analyst (LPA) Cynthia Urena initiated the investigation at the SFH and collected pertinent documents from SFH and client's files. LPA conducted an inspection of the SFH with the Licensee and there were no deficiencies observed. LPA advised the Licensee that Investigator Sonia Sandoval with the Community Care Licensing Division (CCLD) Investigations Branch (IB) would be leading the investigation. Investigator Sandoval conducted interviews with the Licensee, three county staff members, two of three clients (C2, C3) a client involved C1 could not be reached after multiple attempts made by the investigator for an interview. It was reported that C1 is currently on a runaway status and no additional information regarding the allegation was obtained. (**Continued on LIC C**) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cynthia Urena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: SAFE AND SOUND SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/21/2024

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

report_type: Complaint Investigation

met_with: Licensee, Destiny Phillip

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On February 9, 2023 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Safe and Sound Small Family Home license. LPA met with applicant Destiny Phillip who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there is one client in the home. The applicant is applying to serve 4 clients ages 0 to 17. The home is a two story building with six bedrooms and three and a half bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed and one crib, will sleep the licensee and one infant client, and has a master bathroom. · Bedroom #2 (Client's) was vacant has one twin bed, it will sleep one client. · Bedroom #3 (daughter) had one full bed, it sleeps the daughter. · Bedroom #4 (sons) had one full bed, it sleeps the son. · Bedroom #5 (Client's) was vacant has one twin bed it will sleep one client · Bedroom #6 (Client's) was vacant has one twin bed and will sleep one client · A great room/living room, kitchen, dining area, three and one half bathrooms, an office, a loft, an attached two car garage, storage closet, and the backyard. The Client's bedroom was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector/Carbon Monoxide detector in every bedroom. The six smoke detectors/carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located on the side of the home. : The home's tankless hot water heater was located inside the garage and the temperature is set to 120 degrees Fahrenheit. The appliances were in working order. The client's files are locked inside a cabinet in the office. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked cabinet in the garage. The medications are located in a locked box in the pantry. The hot water in the Master Bathroom measured to be 109.4 degrees Fahrenheit. The water temperature of bathroom 1 measured to be 111.3 degrees Fahrenheit. The water temperature in bathroom number 2 measured to be 111.9 degrees Fahrenheit. The hot water temperature in bathroom number 3 was 109.2 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the pantry. Two fire extinguishers were present in the home one is located in the dinning room down stairs and the other is located upstairs in the loft. They were observed to be properly charged and inspected by the fire department. Applicant stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play was completely fenced. There were no deficiencies observed at this time: The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Destiny Phillip.

met_with: Destiny Phillip


summary: Facility Evaluation

raw_content:
Narrative:
On February 1, 2024 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes began day one of an annual inspection for Safe and Sound Small Family Home. LPA met with Licensee Destiny Phillip who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there is three clients in placement. No client was home at the time of inspection. The home is a two story building with six bedrooms and three and a half bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed and one crib, will sleep the licensee and one infant client. · Bedroom #2 (Client's) has one twin bed, it sleeps one client. · Bedroom #3 (daughter) had one full bed, it sleeps the daughter. · Bedroom #4 (sons) had one full bed, it sleeps the son. · Bedroom #5 (Client's) has two twin beds it sleeps two client's. · Bedroom #6 (Guest) has one queen bed and is used as a guest room. · A great room/living room, kitchen, dining area, three and one half bathrooms, an office, a loft, an attached two car garage, storage closet, and the backyard. 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 space for the client's belongings. There was a smoke detector/Carbon Monoxide detector in every bedroom. The six smoke detectors/carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located on the side of the home. The home's tankless hot water heater was located inside the garage and the temperature is set to 120 degrees Fahrenheit. The appliances were in working order. The client's files are locked inside a cabinet in the office. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked cabinet in the garage. The medications are located in a locked box in the pantry. The hot water in the Master Bathroom measured to be 105.8 degrees Fahrenheit. The water temperature of bathroom 1 measured to be 108.6 degrees Fahrenheit. The water temperature in bathroom number 2 measured to be 105.3 degrees Fahrenheit. The hot water temperature in bathroom number 3 measure to be 111 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the pantry and contained all required supplies. Two fire extinguishers were present in the home one is located in the dinning room down stairs and the other is located upstairs in the loft. They were observed to be properly charged and inspected by the fire department. Licensee stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play was completely fenced. LPA reviewed three of three client files they contained all required documents. LPA was unable to do client interviews at this time as no client was was home at time of inspection. LPA reviewed four of four staff files they contained all required documents. LPA interview 1 of 4 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 Destiny Phillip.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On February 7, 2024 at 1: PM, Licensing Program Analyst (LPA) Linda Haynes began day two of an annual inspection for Safe and Sound Small Family Home. LPA met with Licensee Destiny Phillip who allowed entry into the home. Currently there is three clients in placement. There were two client's present at the time of inspection. LPA Interviewed two of three clients. There were no deficiencies at this time. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Destiny Phillip.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On December 11, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Safe and Sound small family home (SFH) 2-year required inspection. There were two clients in placement. The home was licensed for a capacity of four clients (all ambulatory). The Facility was toured both inside and out with licensee. The home is a two-story building with six bedrooms, four and half full bathrooms. During the inspection, LPA observed that downstairs consisted of a lounge used as a dining area, a kitchen, a pantry, a living room. Bedroom #1 was furnished with a full-sized bed, a desk, and used as an office used as an office. It has a full bathroom. Sharp knives, chemicals were inaccessible, stored in a locked cabinet in the garage. The First Aid Kit was in the pantry and contained all required items. Medications were stored in a locked box in the pantry. The garage was inspected, used for cars and for storage. The water temperature was tested and measured at 120 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one a half bathroom fully functioning. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Two fire extinguishers were observed and operable. Upstairs was bedroom #2, it was fully furnished with one full size bed; it sleeps biological daughter, age 16 years. Bedroom #3, it was fully furnished with two twin size beds; it sleeps one client. Bedroom #4 was fully furnished with one twin sized bed; it sleeps one client. Bedroom #5, it was fully furnished with two full-sized bunked beds. It sleeps one biological son, aged 14 years. Bedroom #6 was fully furnished with one king size bed, master bedroom; it sleeps licensee. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. The upstairs space includes additional storage, a loft, fully furnished and an additional bathroom used by the clients. All hazardous items have been properly made inaccessible to areas where clients have access. Cleansers/chemicals were locked in the cabinet in the laundry room. All windows and screens were in good repair. Licensee stated that there were no guns/weapons in the home at this time. There was a total of six cameras, three located outdoors, and three indoors which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Based on today's inspection and observations, there are no deficiencies being cited at this time. A copy of this report will be provided to the licensing program manager for final approval. An exit interview was conducted, and a copy of this report was discussed and provided to licensee, Destiny Phillip.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Linda Haynes met with applicant Destiny Phillip Via Facetime on November 18, 2021 for a Component II. LPA went over revisions needed for the application prior to licensor. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed for the application via Email. Copy of this report was provided to applicant. a signed copy will be placed in facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday February 16, 2022, at 10: AM Licensing Program Analyst (LPA) Linda Haynes conducted a pre licensing inspection of the facility. At time of inspection LPA met with applicant Destiny Phillip. The facility was toured inside and out with applicant Destiny Phillip. The home is a two-story residence with four bedrooms and three bathrooms. Bedroom # 1 is downstairs and furnished with two twin beds Bedroom # 2 is upstairs and furnished with one full bed and sleep's licensee's daughter. Bedroom # 3 is upstairs and furnished with bunk beds bottom bed is full top is twin and sleep's licensee's son. Bedroom # 4 is upstairs furnished with a king bed and a crib and sleeps licensee and will sleep one infant. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathroom was clean and in good repair. Hot water in bathroom number one measured to be 119.6 and bathroom number two 119.4. Bathroom number three is the master bathroom and the clients will not have access to it. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications will be stored and locked in a locked box above the refrigerator. Cleaners/chemicals are locked and stored in locked cabinet under the sink. Sharp knives are inaccessible and stored in a locked box in the garage. The First Aid Kit is located in the medication lock box and contained all required supplies. The facility's smoke detectors in each bedroom were checked and were operable. The carbon monoxide and the smoke detectors are the same. There are no guns or weapons in the facility as stated by applicant Destiny Phillip. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water present. There was no deficiency observed during today's visit. The home was in compliance with Title Regulation. The applicant will be scheduled for a Component III prior to licensure. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview conducted and a copy of this report was discussed and provided to applicant Destiny Phillip this date.


facility_name: SAFE FAMILY HOMES

raw_content:
Narrative:
Information obtained from confidential interviews and review facility file history revealed a lack of evidence to support alleged sexual abuse. Based on confidential interviews with one Youth, assigned Social Worker, and Facility Administrator, the investigation was not promoted due to consistent statements from parties revealing denial of said sexual abuse. The investigation uncovered no information to support the allegation that Resource Parent is sexually exploiting Y1, thus the investigation assignment is not promoted. Therefore, the allegation is determined unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited per California Code of Regulations, Title 22, at this time. A copy of this report is provided to Administrator via email.

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

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

met_with: Kristiana Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On February 22, 2024 at 1: PM, Licensing Program Analyst (LPA) Charmetha White conducted a Component II, Face-to-Face meeting with Safe Family Homes Small Family Home Licensee, Kristiana Johnson. The purpose of the meeting was to discuss the pending Small Family Home application and Program Statement review. The following concerns were discussed: Program Statement: • Treatment • Education • Transportation • Discipline · Emergency Intervention Plan · AWOL/Run Away Plan · Telephone Policy · Mail • Recreation • Protection • Religious Services Report continued on LIC C • Personal Hygiene Items • Personal Allowance/Paid Jobs • Medical/Dental • Record and Reporting FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 3/19/2024 at 10: AM. An exit interview was conducted, and a copy of this report was given to the Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On March 19, 2024, Licensing Program Analyst (LPA) C. White arrived at Safe Family Home Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPA met with Applicant, Kristiana Johnson who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicant and the applicant's minor biological child. The home is set up as follows: This is a two-story 5 bedroom, 3 ½ bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, loft, office, laundry room, a backyard, and an attached garage. Living room: is equipped with mounted TV, a sectional sofa, two (2) chairs, a coffee table, and a small cabinet. The living room also has sliding glass patio doors leading to the backyard. Dining room: is equipped with marble table with five (5) chairs and a bench. Kitchen: is equipped with a refrigerator/freezer, a five (5) burner gas stove (all burners were operational at the time of the inspection), double oven, microwave, and a dishwasher. Sharp knives are kept locked in the applicant's bedroom and made inaccessible to clients when in care. LPA observed a covered trash can, a pantry, plenty of cabinet space, ample plates, cups, and eating utensils. LPA observed ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. The applicant will ensure that three (3) nutritious meals and snacks will be provided to the clients. Loft/entertainment area: is located on the second floor and contains TV's, a sofa, desk, chair, computer, and a PlayStation. Office: is located on the first floor and contains a desk, chairs, sofa, computer, printer, and a locked file cabinet. The cabinet will be used to store client files. Laundry room: is located on the second floor of the home between bedroom #1 and bedroom #2. The room has a washer, dryer, built-in cabinets and drawers, and contains washing supplies. The room is kept secure with a combination lock and remains locked at all times. Report continued on LIC 809C. (Page 1 of 3) Backyard: contains a built-in BBQ grill, a fenced and gated fire pit and in-ground pool. The pool fence meets regulations, and the pool gate has self-closing latch to ensure the body of water is inaccessible to clients when in care. The pool pump/filtering system is located on the side of the home. When pool is in use by clients, applicants will ensure that individual supervising clients in the pool area are Water Safety trained. Attached garage: used for the home's vehicle. The garage also contains an extra refrigerator, table and chairs. LPA also observed the garage to be used storage. Bedroom #1: is located on the second floor and will be used as a client's room. The room has two (2) twin beds, two (2) dressers with five (5) drawers each, a TV, a closet, working light, and windows. The room also has an attached bathroom that contains a shower/tub, toilet, and sink. Bedroom #2: is located on the second floor and will be used as a client's room. The room has two (2) twin beds, two (2) dressers with four (4) drawers each, a TV, a closet, a desk and chair, working light, and windows. The room also has an attached jack and jill bathroom that contains a shower/tub, toilet, and sink. Bedroom #3: is located on the second floor and will be used as a client's room. The room has two (2) twin beds, two (2) dressers with four (4) drawers each, a TV, a closet, working light, and windows. The room also has an attached jack and jill bathroom that contains a shower/tub, toilet, and sink. Bedroom #4: is located on the second floor and it is occupied by the applicant. This room has a combination lock and it is equipped a king size bed, dresser, working light, and windows. The room also has an attached bathroom that contains two (2) sinks, a tub and separate shower, and a walk-in closet. Bedroom #5: is located on the first floor and it is occupied by the applicant's minor biological child. The room has a queen size bed, a sofa, a dresser, TV, working light, and windows. (3.5) Bathrooms: one bathroom is located in bedroom #1, the second bathroom is located along the hallway between bedroom #2 and bedroom #3, one bathroom is located in bedroom #4, and the ½ bathroom is located on the first floor to the right of the entrance. The ½ bathroom contains a sink and toilet. LPA found all bathrooms to be clean and in working order. The hot water was tested and found to be with 105-120 (F). Report continued on LIC 809C. (Page 2 of 3) Vehicle: The applicant will use a Tesla Model X to transport clients in care. The vehicle is in good condition with current registration through 01/07/2025 and insurance with USAA current through 09/01/2024. The home's temperature is maintained by central air/heating. LPA observed one (1) fully charged fire extinguisher. Extra linens are stored in the laundry room. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was found to be be complete. Disinfectants and cleaning solutions are kept in the laundry room. The home has a working telephone readily accessible to children in care. Medications will be kept locked in file cabinet located in the office. Medications requiring refrigeration will be kept in a locked box stored in the garage refrigerator. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. Applicant will ensure grievance process, Disaster Plan, Discipline policies and procedures will be posted in dining room area. During the inspection, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Per a check in Guardian conducted on 03/19/2024, the applicant's Criminal Record Clearance states "in process". LPA informed applicant that a Component 3 meeting will be held once applicant obtains eligible clearance. An exit interview was conducted. A copy of this report left with the applicant. (Page 3 of 3)

met_with: Applicant - Kristiana Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On April 22, 2024, at 10: AM, Licensing Program Analyst (LPA) C. White conducted a Component III office meeting at the El Segundo Children's Residential Regional Office for Safe Family Home (SFH). Attending Component III was Kristiana Johnson: The purpose of this meeting was to discuss the forms that are required to be maintained, available, and posted at the facility for inspections per Title Division Chapter 1 (General Regulations) and Title 22, Division 6, Chapter 4 (Small Family Homes). LPA went over the following: Child's Records: General regulation section code 80070 & Small Family Home regulation Personnel records: General regulation section code Reporting Requirements: General regulation section code 80061 & Small Family Home regulation Intake: General regulation section code 80068 & Small Family Home regulation 83068. Compatibility: *Useful documentation Small Family Home regulation 83068.2* Supervision: General regulation section code 80078 & Small Family Home regulation Removal/Discharge Complaint Procedures Food: General regulation section code 80076 & Small Family Home regulation Hygiene (toiletry) Prudent Parenting: Small Family Home regulation Pending final approval of LPA C. White will submit the application for licensure. A Copy of this report was provided to the applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2024, at 09:45am, Licensing Program Analyst (LPA) Kim Dear, made an announced visit to the Safe Family Homes located at Golden Maple Drive, Santa Clarita, CA 91387, for the purpose of conducting a post licensing visit. Registered person and House Manager, Kyle Flourney allowed LPA access into the property and tour of the home. All clients were away from the property at time of visit. There are currently 3 of 6 children in placement. Interior: The property is two stories consisting of (5) five bedrooms. (1) One bedroom is available on the lower level next to kitchen area. A full-sized kitchen consists of a double door refrigerator, microwave oven, double oven, dish washer and additional top ranged stove. Food storage is abundant in full panty, canned goods in cabinets and perishable foods in refrigerator and double, draw freezer. Water was tested to be 103 degrees. Office space is also on the lower level to the east of the kitchen. Office is equipped with large desk, chair, computer and a large window. Office is used for participants intake. Upstairs locates the master bedroom, king sized bed, dresser drawer, night stands a closet and a television. Full Laundry room was equipped with washer and dryer. All (3) three bedrooms contain a closet within swing doors, a single twin sized bed, television, lamp, and dresser. The first bedroom has an adjourning full restroom: Restroom contains a cabinet, sink toilet bathtub and shower space. The second and third bedrooms share an adjourning full restroom: cabinet, sink toilet bathtub and shower space. See 809-C Exterior: Large outdoor lawned area surrounds a fended in pool. A table, seating (6) six is placed on the concrete portion of the yard. An additional patio area is also available shaded under a large umbrella. Additional outdoor furniture for seating also was observed. At conclusion of safety inspection, the facility is able to continue to be licensed to provide transitional housing placement services to minor dependents; up to (06) six participants, ages 3-17 years of age. At the inspection's conclusion, it was determined that all practices and procedures maintain compliance. An exit review was conducted with the House Manager and a copy of the inspection was provided. No deficiencies were identified at this time.

met_with: Kyle Flournoy


summary: Facility Evaluation

raw_content:
Narrative:
On 7/10/25, at 9:05 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection. LPA Gomez met with Facility Manager (FM), Kyle Flournoy, who granted access to the facility. The current census is 4. This facility is licensed to provide care and supervision for six (6) children ages 3-17 years old, ambulatory only. There is a swimming pool on the premises. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Living Room: equipped with a large couch, coffee table, mounted television, and 3 chairs. Kitchen: equipped with a double door refrigerator, microwave, oven, dishwasher and top range stove. The pantry and refrigerator contained ample food for children in care that included both perishable and non-perishable foods. All appliances are in working order. The trash can in the kitchen was equipped with a lid. Bedroom #1: located upstairs. This master bedroom is currently occupied by Caregiver Kristiana Johnson. The bedroom is equipped with a king-sized bed, dresser drawer, nightstands, a closet and a television Continue on 812-C(Page 1) Bedroom #2: located upstairs. This bedroom is currently occupied by C2. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bathroom #1 is adjourned to Bedroom #3. It is equipped with cabinet, sink, toilet, and bathtub/shower. Bedroom #3: located upstairs. This bedroom is currently occupied by C3. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bedroom #4: located upstairs. This bedroom is currently occupied by C4. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bathroom #2: This full restroom is adjourned to Bedroom #2 and Bedroom #3. This bathroom is equipped with a cabinet, sink, toilet and bathtub/shower. Bedroom #5: located downstairs. This bedroom is currently occupied by C1. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bedroom #6: located downstairs. Equipped with large desk, chair, full-sized bed, television and a computer. This space is used for staff. FM stated that the space is only used by staff to relax. Loft: equipped with a table, couch, television, computer, and desk. FM stated that the space is used for client intakes, but clients do not use the space. Laundry Room: equipped with a washer and dryer that are in working order. Bathroom: There are a total of 4 bathrooms in the facility. 3 upstairs and 1 downstairs. Backyard: space is equipped with a pool (enclosed by a gated fence), grill/countertop space, and a faux grassed area. Continue on 812-C (Page 2) Additional Observations: The water temperature at the kitchen sink was tested and measured at 115 degrees Fahrenheit which meets licensing regulations. The cleaning supplies are stored in a locked closet cabinet in the master bedroom. Sharps are stored in a locked closet cabinet in the master bedroom. There are one (1) fire extinguishers located downstairs by the back sliding door. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed the personal rights posted in the living room. There are a total of 3 cameras located on the outside of the facility. One camera is located in the backyard, one camera is located in the front yard by the garage and a ring doorbell camera. Vehicles: LPA Nestor inspected one (1) facility vehicles in total. Kia K5 (grey) with current registration that expires in 10/08/2025. Insured by Garrison Prop and Cas Ins Co that expires on 9/1/2025. The vehicle is in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interview with S1 and S2. Client Interview: LPA Nestor conducted two (2) client interviews with C2 and C4. LPA Nestor will return to complete the inspection. There were 4 deficiencies observed or cited at this time. See 809-D. A copy of this report was reviewed and provided to caregiver Kristiana Johnson. End of Inspection (Page 3)

met_with: Kyle Flournoy - caregiver


summary: Facility Evaluation

raw_content:
Narrative:
On January 29, 2026, at 2: PM, Licensing Program Analyst (LPA), Aimee Moratalla conducted a case management - other (a follow up) on an incident investigation at Safe Family Home SFH and met with the Licensee, Kristiana Johnson. The incident report concerning lack of supervision was received by the department on 11/17/2024. During this visit, LPA spoke to the Licensee regarding the incident. LPA Moratalla requested copies of the following documents: Client Roster (LIC9020) and Personnel Report (LIC500). Based on the interview and information gathered, this case management, the Department determined no further investigation is needed. There are no deficiencies cited per California Code of Regulations, at this time. Exit Interview conducted, and a copy of this report will be emailed to Licensee.

met_with: Licensee, Kristiana Johnson


raw_content:
Narrative:
Facility Administrator (S1) implemented crisis communication intervention techniques to redirect C1's reported aggressive assaultive, sexualized behavior. C1's authorized representative was contacted via text message, via email correspondence and with the placement agency. S1 followed directives and as advised submitted a 14-day notice and contacted Law enforcement to ensure the safety of other clients and staff. The placement agency ensured to pick up C1 from the police station as soon as additional staff was available to transport. S1 submitted incidents report within the proper timeframe, and evidence determined that S1 ensured that C1's personal belongings and prescription medication were provided to the placement agency. Due to a lack of evidence obtained during the investigation, LPA Gray determined that the allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was emailed to the facility representative and the Administrator (S1)

Investigation Findings:
13On 01/21/2026 at 12: PM Licensing Program Analyst (LPA) Andrew Upshaw made an unannounced visit to conclude the complaint investigation. Prior to entering the facility LPA Upshaw conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all relevant parties available and gathered pertinent information in reference to the allegation. Based on confidential interviews and documentary evidence, there is no evidence to determine that the facility Resource parent abandoned foster child. Records determined that there was no lack of communication to report Client 1's (C1) behavior and to provide proper supervision. -Continued on Lic9099-C- UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Andrew Upshaw LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: SAFE FAMILY HOMESFACILITY NUMBER: VISIT DATE: 01/21/2026

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

met_with: Kyle Flournoy, Assistant Caregiver


facility_name: SEALSTONE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 22, 2024 at 08:30AM, Licensing Program Analysts (LPAs) Adaleyci Caballero and Rachel Vanegas met with applicant John Nwosu via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. Lpa a. Caballero gave a copy of the this report, 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. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-John Nwosu


summary: Facility Evaluation

raw_content:
Narrative:
On July 31 2024, at 12:00PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Sealstone Small Family Home (SFH). LPA met with Applicant John Nwosu 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 5 bedrooms and two full bathrooms and one half bathroom which are set up as follows: · Bedroom #1- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients Bedroom #5- will sleep applicant. A living room, family room, kitchen, dining area, laundry room, three car garage, and bedroom #4 will be utilized as an office. The home has 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. Smoke Detector and Carbon Monoxide detectors are combined. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. Medications will be locked in a lock safe in the office. The hot water was at a temperature of 141.9 degrees Fahrenheit. The First Aid kit was accessible and was placed in a drawer in the kitchen area. There was two fire extinguishers present in the home located in the second floor's hallway and downstairs in the kitchen area. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced. The home has two cameras on the outside premise and two cameras in the common areas of the home. Corrections to be made: Food storage space and a supply of three days of perishable foods and a week of non-perishable foods. Sharp knives should be locked and inaccessible to clients in care. Water temperature was observed at 141.8 degrees Fahrenheit. Applicant's bedroom should be furnished with applicant's belongings. Locked storage for cleaning solutions and other hazardous items. Thermometer in the First-Aid kit. A trash can with lid in the kitchen area. Games, educational supplies, and adequate equipment for the clients. Safeguard for cash resources Pots and pans Extra linen and towels for clients in care. Telephone service Clean backyard and remove weeds. Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, and visitation policies. An exit interview was conducted, and a copy of this report was provided to applicant John Nwosu.

met_with: Licensee-John Nwosu


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report to the pre-licensing visit on 08/13/24. On August 13, 2024, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant John Nwosu to conduct a pre-licensing inspection of the revisions made from the first pre-licensing inspection conducted on July 31, 2024. LPA inspected the SFH and the following corrections were observed; sharp knives should be locked and inaccessible to clients in care, water temperature 120.1 degrees Fahrenheit, applicant's bedroom should be furnished with applicant's belongings, locked storage for cleaning solutions and other hazardous items, thermometer in the First-Aid kit, a trash can with lid in the kitchen, games and educational supplies, and adequate equipment for the clients, safeguard for cash resources, pots and pans, telephone service, clean backyard and remove weeds, Emergency Disaster Plan (LIC 610), Personal Rights, Grievance Procedures, and Visitation Policies. Corrections pending: Extra linen Three days of perishable food Trash in garage An exit interview was conducted and a copy of this report was provided to applicant John Nwosu.


summary: Facility Evaluation

raw_content:
Narrative:
On September 10, 2024, Licensing Program Analysts (LPAs) Adaleyci Caballero and Rachel Vanegas met with applicant John Nwosu who granted access to the facility. The purpose of the visit was to conduct a Component III training of the application process. An exit interview was conducted and a copy of this report was provided to applicant John Nwosu.


facility_name: SECOND CHANCES SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 07, 2024, Licensing Program Analyst (LPA) Karen Beal conducted an application review. The revisions that are needed for your application was provided. The documents can be mailed to my attention at the office or brought into the office. Please do not forget the remaining documents must be submitted within 30 days. Thank you.

met_with: Martha Nunez, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, 2024, at 12: PM, Licensing Program Analyst (LPA) Karen Beal began a pre-licensing inspection and component III for Second Chances Small Family Home for an initial license. LPA met with applicant Martha Nunez who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant is currently a resource family home with Knotts Foster Agency(FFA). Currently there is one child in the home that was placed by the FFA. The applicant wishes to be licensed for 3 children ages 0 to 17. The home is a single-story building with three bedrooms and 2 bathrooms with a Casitas which is set up as follows: · Bedroom # Has two twin beds, it is currently vacant. · Bedroom # Has a full size bed and sleeps the resource child. Bedroom # Master bedroom. Its sleeps the applicant and spouse Casitas- has a queen bed and it sleep applicant's son A formal living room, formal dining room, living room, kitchen with dining area, two bathrooms, three car garage, backyard with pool, and a laundry room. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly.A cell phone will be available for client use in place of a landline and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Continued to LIC 809-C Continued from LIC Sharp knives and sharp objects were locked in a cabinet in the kitchen. Cleansers/chemicals were inaccessible and stored in laundry room which has a lock on the door. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 112.6 degrees. First Aid kit was accessible with all required items, and it was in the hallway closet. A Fire extinguisher was observed and properly charged. The electric fireplace was in the living room area, it stays cool to touch. All the appropriate forms were posted in view of facility clients. As stated by applicant, there is weapons/firearms in the Casitas The weapon is stored in a safe and the ammo is stored in the closet in a lock box. There is a gated pool and a spa. The backyard where children will have access to play was completely fenced and free of hazards. The request for licensure will be forwarded to Licensing Program Manager for final approval. Applicant was advised to contact the department within 30 days of their first placement. LPA conducted Component III training. An exit interview was conducted. A copy of this report was provided to applicant Martha Nunez


facility_name: SERENITY HAVEN

summary: Facility Evaluation

raw_content:
Narrative:
On July 8, 2025 at 9:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Carol Noyes-Mora 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 August 8, 2025. The pre-licensing inspection is scheduled for July 21, 2025 at 10:00AM. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application 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-Carol Noyes-Mora


summary: Facility Evaluation

raw_content:
Narrative:
On July 21, 2025 at 3:00PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Serenity Haven Small Family Home (SFH). LPA met with Applicant Carol Noyes-Mora 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 two-story building with five bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #2- It consisted of one queen bed. The bed had linen, comforters, and pillows. It will sleep applicant. Bedroom #3- It consisted of one queen bed. The beds had linen, comforters, and pillows. It will sleep applicant's bio adult son. Bedroom #4- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #5- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. A living room, family room, office, kitchen, dining area, laundry room, loft, 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 eleven smoke detectors were checked and working properly. The Carbon Monoxide detectors were combined with the smoke alarms. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Medications and sharps will be locked in a secure box inside the pantry. Client and staff files will be locked inside a filing cabinet in the office. The home had a trash can for storage of solid waste with a tight fitting lid. Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, Facility Sketch, House Rules, and Visitation Policies were posted in the entrance. There were two fire extinguishers present in the home located in the downstairs closet and the upstairs linen closet. They were observed to be properly charged and inspected by the fire department. The First Aid Kit was located in the kitchen accessible to clients in care. There are no firearms in the home. There is no pool or any body of water in the home. There are no cameras in the home. The hot water temperature was at 105.2 degrees Fahrenheit. Corrections: Telephone Service Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Carol Noyes-Mora via email due to technical difficulties. The application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.


summary: Facility Evaluation

raw_content:
Narrative:
On October 1, 2025 at 11:09AM, Licensing Program Analyst (LPA) Cynthia Ramos met with Licensee Carol Noyes Mora who led a tour of the home. Licensee granted LPA access to the home. The purpose of the visit was to conduct a Post Licensing Inspection at Serenity Haven Small Family Home (SFH). The facility was toured inside and out with the Licensee. There were three clients placed in the home. The home is a two-story home with 5 bedrooms and 3 bathrooms. On the first floor of the home, there was Bedroom #1 which consisted of a full size bed and adequate drawers, this room will be used for future clients and was vacant. Next there was two living rooms with large couches and televisions that clients have access to. The kitchen was also inspected and was free of hazards and there was a large dinning table. Additionally, there was a half bathroom on the first floor. The second floor of the home was as follows: Bedroom #2 is master bedroom which was occupied by Licensee. Bedroom #2 contained a queen size bed and was occupied by Licensee's adult son. Bedroom #3 contained two twin size beds and had adequate bedding, this room was occupied by five-year-old male client. Bedroom #4 contained two twin size beds with adequate drawer space and was occupied by two male clients both nine years old. There was also a large living room area where clients have access to and play. All bathrooms in the home were inspected and were working properly. The laundry room was locked and contained detergent and cleaners. 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 was adequate drawer and closet space for client's belongings. ... All hazardous items have been properly made inaccessible to clients. The medication locked box, cleansers/chemicals and knives were locked in the kitchen's pantry and were not accessible to the clients. The first aid kit was located in the kitchen and contained all required items. Per Licensee, there are no weapons/guns in the home at this time. There were two fire extinguishers in the home. The hot water temperature was tested and noted to be 105.6 degrees Fahrenheit. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted. The backyard where children have access to play is completely fenced and free of hazards.The garage was also inspected and free of hazards. The home does not have a pool or bodies of water. A total of 3 staff records and 3 client records were reviewed and were in compliance. A total of 1 staff interview and 1 client interview were completed. Based on today's inspection, there are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was provided to the Licensee Carol Noyes Mora.

met_with: Licensee, Carol Noyes-Mora


facility_name: SHAKA FINNELL RESIDENTIAL CARE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
who confirmed this information regarding C1. While other confidential information received by Licensing Office stated that these allegations had occurred. There were no other known witnesses to these allegations. Based on confidential information obtained during the course of this investigation, the allegation that minor was physically abused resulting in injury, more specifically that C1 was hit in the face by Co- Licensee (A2), may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Licensees, Shaka Finnell and Ellis Jones to discuss the investigative findings for the above stated allegation. Licensing Program Analyst (LPA), Daniel Mena conducted an inspection to the Small Family Home (SFH) on April 06, 2022. Special Investigator (SI), Marlon Williams interviewed both Licensees (A1 & A2), County Social Worker (CSW), as well as reviewed client interviews, police, facility and client records. Community Care Licensing received information on April 01, 2022 alleging that minor was physically abused resulting in injury, more specifically that C1 was hit in the face by Co- Licensee (A2). Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied that anyone in the home had ever hit or physically mistreated C1. According to confidential information obtained, C1 has a documented history of making false allegations and self-injurious behaviors. Investigator Williams spoke to C1's County Social Worker UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: SHAKA FINNELL RESIDENTIAL CAREFACILITY NUMBER: VISIT DATE: 07/18/2022

met_with: Ellis Jones


summary: Facility Evaluation

raw_content:
Narrative:
On Friday January 28, Licensing Program Analyst (LPA) Linda Haynes attempted to complete an annual inspection of Shaka Finnell Small Family Home. LPA arrived at 10: AM to begin the inspection LPA rang doorbell and knocked on door there was no answer. LPA left business card on the door with a note on the back that request a phone call. LPA will attempt another visit on Monday January 31, 2022.


summary: Facility Evaluation

raw_content:
Narrative:
On January 31, 2022 at 10: AM Licensing Program Analyst (LPA) Linda Haynes began an annual inspection for Shaka Finnell Residential care. LPA met with Licensee Shaka Finnell and Ellis Jones who led a tour of the home. The facility was toured both inside and out with the Licensees. The home consists of: Bedroom #1- It has two single bed- Vacant. It will sleep two foster children. Bedroom # 2- It has one single bed- It sleeps licensees' biological 13-year-old daughter. Bedroom # 3- It has two single beds and sleeps one foster child and one bed is vacant. Bedroom # 4- It has one king bed and It sleeps Licensees Bedrooms were arranged so that no more than two children share a room. There was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The home had 3 bathrooms. Inside the facility there were operable smoke detectors located in each bedroom and common areas. There was also an operable carbon monoxide detector located in the hallway. There were a family room and one living room next to the front entrance which is also designated to visitation. There was an area which contained toys and sports equipment that were observed to be safe, clean, and age appropriate for the age group of children to be cared for. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. LPA Haynes observed a minimum of 7-day non-perishable and a 2-day perishable supply of food. The medication was in the lock box located in the licensee's bedroom closet inaccessible to children. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored in a lock box located in the office desk area. First Aid kit was also accessible and had all required items. The hot wProper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The Facility Sketch; Emergency Disaster Plan; Personal Rights and visitation policy were posted. There were no guns or weapons as stated by Licensee at this time. The backyard was observed to be clean and free of hazards. There was a game room linked to the garage. It had two pool tables, a bathroom and a sink. There was no pool or other body of water. Based on this inspection there is one type B violation. Exit interview conducted and a copy of this report and LIC 809D was discussed and provided to applicants this date.


summary: Facility Evaluation

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Narrative:
On Tuesday November 21, 2023 at 1: PM Licensing Program Analyst (LPA) Linda Haynes met with Co Director Ellis Jones to complete a case management inspection in regards to an incident of the death of Client 1 (C1) on 11/6/2023. See LIC 811 dated 11/21/2023 for names of clients in care. LPA interviewed Ellis Jones, and Client 2 (C2). LPA also collected the following documents AWOL notes for C1 for the following dates 11/6/2023, 11/5/2023, 11/4/2023, 11/2/2023, 10/21/2023, 10/25/2023, and 10/29/2023, Health and Education Passport for C1, contact information for caregivers for C1, Agency Small Family Home Foster Parents Agreement for C1, Medi-cal coverage letter for C1, Letter to County Social Worker (CSW) about C1's behavior, and Needs and Case Plan Summary for C1. LPA completed a safety walk through of the home no safety concerns at this time. LPA will call to speak with Licensee as they were not present at the time of visit. The death of C1 will be followed up on as our department receives information from law enforcement and the coroner's office. No violations will be cited at this time A copy of this report LIC 811 and appeal rights was given to Ellis Jones.


summary: Facility Evaluation

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Narrative:
On August 30, 2024 at 09: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived to the facility listed above for the purpose of conducting an annual inspection. LPA met with Licensee Ellis Jones who led a tour of the home. The facility was toured inside and outside with the licensee. The home consists of: Bedroom #1 - Has a sofa bed and is used as a study space while there are zero children in care. It will have to two single beds and will sleep two foster children. Two new single beds have been ordered and will be set up within one week. Licensee will submit a photo of the new beds in bedroom #1 to licensing. It contains ample closet space with adequate storage for personal belongings, etc. Bedroom #2 - Has one single bed and is currently vacant. It will sleep one foster youth. It contains a dresser and closet with adequate storage space for personal belongings, etc. Bedroom #3- Has one single bed and sleeps the licensees' biological 17-year-old daughter. Bedroom #4- Has one king bed and sleeps the Licensees. Bedrooms were arranged so that no more than two children share a room and will have one child per bed. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. Inside the facility there were operable smoke detectors located in each bedroom and common areas. There was also an operable carbon monoxide detector located in the hallway. The facility has an accessible fire extinguisher that is properly charged and inspected located in the kitchen. There is one recreation room and one living room, which is designated for visitation(s). There are accessible board games and toys that were observed to be safe, clean, and age appropriate for the children to be cared for. The facility has a fireplace in the living room and was observed to be properly screened. **** Telephone service and appliances were in working order. The kitchen hot water temperature was measured and registered at 118.0 degrees F. The laundry room is located adjacent to the kitchen. All hazardous items such as cleaning products and laundry detergent have been properly made inaccessible to areas where children will not have access. LPA observed a minimum of 7 days of non-perishable food in the pantry and a 2 day perishable supply of food. Knives are stored in a locked box/storage container where children in care will not have access in a storage closet outside of the licensees' bedroom. Medication are stored in a separate lock box located in the storage closet outside of the licensees' bedroom, inaccessible to children in care. A first aid kit was accessible and had all required items. LPA provided technical assistance and discussed with the Licensee the importance of documenting biannual disaster drills and including the date, type of drill, and participants of the drill, etc. for proper Operations compliance with Disaster and Mass Casualty Planning. The current census is Zero and prior to receiving any children in care, this will be corrected. The Facility License, Facility Sketch, Emergency Disaster Plan, Personal Rights, meal menus, and visitation policies were posted in the kitchen. There are no guns or weapons on the facility grounds, as stated by the Licensee at this time. The backyard was observed to be clean and free of hazards. The backyard has a basketball hoop set-up for outdoor activities for the children in care. There is no pool or other body of water at the facility at this time. An exit interview was conducted and a copy of this report, LIC 9102, and appeal rights were discussed and provided to Licensee - Ellis Jones.

met_with: Ellis Jones - Licensee


facility_name: SHALLOWHORN SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On June 3, 2021 at 3: PM, Licensing Program Analyst (LPA) Kourtney Williams arrived at the Shallowhorn Small Family Home to conduct an annual inspection. LPA met with Licensee Danielle Shallowhorn who granted LPA access to the home. At 3: PM, LPA began a tour both inside and out with the Licensee. There were two children in the home at the time of this inspection. The home was set up as follows: • Bedroom #1 upstairs had a television , a couch, folding table, chairs and dressers. There is a secondary sink area that is closed off from the room. • Bedroom #2 upstairs had two twin beds. It sleeps a 9 year- old foster child #1 (FC1) and a 6- year foster child #2 (FC2). • Bedroom #3: upstairs had two vacant twins' beds and a television. • Bedroom #4: upstairs is a guest room had a queen size bed. • Bedroom #5: upstairs sleeps the Licensees 16 - year old biological son. There is a queen sized bed in the room. Bedroom#6: upstairs is the master bedroom with an attached bathroom. It sleeps Licensee and husband. • Bedroom #7 : downstairs is the Licensee's office. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The fireplace was properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications were locked and stored downstairs in the licensee's office. Cleansers/chemicals were locked and stored in a locked closet downstairs in the hallway. Sharp knives were inaccessible and locked in a closet in the downstairs hallway. The first aid kit was located in the kitchen in a lower cabinet located by the kitchen entrance. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be within regulation requirement. Proper storage of all food was noted. Trash cans for storage of solid waste had tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted at this time. The backyard where children will have access to play was completely fenced and free of hazards. There was no pool or other body of water on the premises. Toys were safe, clean, and age appropriate for the age group of children being cared for. CPR and the First Aid cards expires on 09/23/21. Children and staff records are organized. Administrative records included: A review of one staff and two client's records on this date indicates that all facility. Staff have received criminal record and child abuse index check clearances and required documents, In accordance with Title 22, Division 6, Chapters 1 & 4, there were no deficiencies being cited at this time. Based on this annual inspection, the home was operating within a full capacity of three children. Exit interview conducted and a copy of this report and confidential names List (LIC 811) were given and explained to the licensee.

met_with: Danielle Shallowhorn


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Narrative:
Regarding the allegation that licensee engaged in inappropriate interaction with foster child resulting in injuries, it was specifically alleged that L1 took a board game from FC1 and in the process of taking it scratched FC1. During investigation, confidential interviews stated that during an incident FC1 had forced their way in to L1's office and grabbed a box that was in the office and while attempting to run out of the office L1 tried to grab the box and accidentally scratched FC1. LPA was unable to interview FC2 and there were no other witnesses to the incident. LPA was unable to interview FC1 due to not being able to contact FC1's new guardian. LPA was unable to gather additional information. Based on confidential interviews, the allegations that licensee engaged in inappropriate interaction with FC1 resulting in injuries may have occurred, however, there was not a preponderance of evidence to support the alleged violation. Therefore, this allegations is unsubstantiated at this time. LPA Enriquez had a telephone contact with the licensee Danielle Norman, she provide verbal authorization to LPA to allow her assistant Ariana Torres to sign report. An exit interview was conducted, and a copy of this report along with the appeal right were reviewed and provided to facility representative.

Investigation Findings:
13On September 18, 2024, Licensing Program Analyst (LPA) Rafael Enriquez arrived at Shallowhorn Small Family Home (SFM) and met with Assistant Ariana Torres to deliver the finding for the allegation stated above involving the SFM's staff and foster children (FC1 and FC2) as listed on the Confidential Names List (LIC 811) dated September 18, 2024. On February 16, 2024, Community Care Licensing (CCL) received a complaint alleging that licensee engaged in inappropriate interaction with foster child resulting in injuries. On February 21, 2024, LPA Enriquez initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, no immediate health and safety hazards were observed. During the inspection, LPA interviewed licensee (L1) and staff 1 (S1). LPA was not able to interview FC2 due to FC2 being non-verbal. LPA attempted to be in contact with FC1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: SHALLOWHORN SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 09/18/2024

met_with: Assistant- Ariana Torres


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Narrative:
Regarding the allegation that licensee restricted a foster child's food intake, it was specifically alleged that L1 restricted FC1's breakfasts and dinners due to FC1 being overweight. During investigation, confidential interviews denied that FC1 was restricted on eating. It was added that FC1 was able to eat whenever FC1 wanted and was told not to snack so much but never restricted. LPA was unable to interview FC2 because FC2 was nonverbal. LPA was unable to gather additional information. In regard to the allegation licensee forced a foster child to wear an inappropriate clothing item, it was specifically alleged that L1 forced FC1 to wear a girdle to school. Confidential interviews denied that L1 forced FC1 to wear a girdle. It was added that L1 bought FC1 some compression shirts but did not force FC1 to wear them. LPA was unable to gather additional information. Based on confidential interviews, the allegations that licensee restricted a FC1's food intake and licensee forced FC1 to wear an inappropriate clothing item may have occurred, however, there was not a preponderance of evidence to support the alleged violations. Therefore, these allegations are unsubstantiated at this time. LPA Enriquez had a telephone contact with the licensee Danielle Norman, she provide verbal authorization to LPA to allow her assistant Ariana Torres to sign report. An exit interview was conducted, and a copy of this report along with the appeal right were reviewed and provided to facility representative.

Investigation Findings:
13On September 18, 2024, Licensing Program Analyst (LPA) Rafael Enriquez arrived at Shallowhorn Small Family Home (SFM) and met with Assistant Ariana Torres to deliver the finding for the allegations stated above involving the SFM's staff and foster children (FC1 and FC2) as listed on the Confidential Names List (LIC 811) dated September 18, 2024. On March 05, 2024, Community Care Licensing (CCL) received a complaint alleging that licensee restricted a foster child's food intake and licensee forced a foster child to wear an inappropriate clothing item. On March 06, 2024, LPA Enriquez initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, no immediate health and safety hazards were observed. During the inspection, LPA interviewed licensee (L1) and staff 1 (S1). LPA was not able to interview FC2 being nonverbal. LPA was not able to interview FC1 due to FC1 was under guardianship and LPA was not able to contact FC1 or FC1's guardian. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: SHALLOWHORN SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 09/18/2024


summary: Facility Evaluation

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Narrative:
On October 7, 2022 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for the Small Family Home license. LPA met with applicant Danielle Norman, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change in location. The home consists of: Downstairs: Bedroom #1, It was furnished with a queen bed, had a bathroom, a living room and a laundry. It is a mother-in-law suite. It sleeps applicant's mother Bedroom #2, It was furnished with a queen bed, had a bathroom. It was used as a guest bedroom There were also an office, a living room, dining area, a kitchen, a half bathroom and a pantry. Upstairs: Bedroom #3, The room was furnished with a queen bed had a bathroom. It was used as a guest room - vacant. Bedroom #4, The master bedroom, furnished with a king-sized bed, had a bathroom. It sleeps applicant and spouse. Bedroom #5, The room was furnished with two twin beds. It will sleep two residents. Bedroom #6, The room was furnished with a full sized bunked bed. It sleeps one resident. Bedroom #7, The room was furnished with a table and a desk. It was used as an office. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility there was no fireplace. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the office closet area. Cleansers/chemicals were locked and stored in the closet by the kitchen. Sharp knives were inaccessible and stored in the kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 107.5 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Licensee, Danielle Norman


summary: Facility Evaluation

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Narrative:
On January 24, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Shallowhorn Small Family Home (SFH) to conduct an annual inspection. LPA met with licensee Danielle Norman who led a tour of the entire home. The home is a two story residence with 7 bedrooms and 6 bathrooms. The home is approved for 3 ambulatory clients. The downstairs consist of an entry way with visitor sign in log, a vacant guest bedroom with a king size bed fully furnished, an office that is locked at all times and holds all client and personnel records as well as emergency disaster plan, license, client roster and cash resources. Downstairs also has a bathroom that is fully functioning and stocked with all necessary toiletries. A storage closet with games and books for clients. There is a living room that is fully furnished with television and couches. The kitchen had a dining table, fully stocked refrigerator and pantry with both perishable and non- perishable foods. The pantry stored the first aid kit with all required elements. There was a locked storage closet that stored all cleaning supplies and sharps/knives. There is fire extinguisher next to garage door and a nook that stores extra waters and another guest room that is currently vacant with a queen size bed and bathroom. The upstairs consists of a bed room for licensee's biological son (which is locked at all times as he is in college), a master bedroom with a king size bed and master bathroom for licensee (also locked at all times), there is a loft that stores an up to date fire extinguisher and escape ladder, there is a storage closet that stores medication and medication logs. There is a laundry room locked at all times with a locked cabinet storing laundry detergent and laundry supplies. There is also a bathroom that is fully functioning with water temperature reaching 114.4 degrees Fahrenheit, a trash can with tight fitting lid and all necessary hygiene supplies for clients. There is a fully furnished bedroom that sleeps one client with one twin size bed currently vacant and one full size bed that is utilized for one client. The bedroom has enough closet and drawer space for two clients as well as bedding has all required elements and lighting. There is another client bedroom that sleeps one client and has two full size beds one utilized for client and one vacant. There is storage/clothing space, and working light fixtures. The bedrooms were arranged so that there was one client to a room, and there was one client per bed and individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses are in good repair. There were no firearms or weapons in the facility as stated by Mrs. Norman at this time. The garage stores parked cars, deep freezer with frozen goods, a locked cabinet for hazardous items and other house supplies/decor. The backyard is free of hazards and has adequate space for activities. There is a storage shed in the backyard that is locked at all times and stores holiday decorations and other house supplies. All hazardous items have been properly made inaccessible to areas where clients will have access. There is no pool or other body of water. During file review one staff member has done a Tuberculosis test however staff member is still awaiting results. Licensee understands that test result need to be given to LPA as soon as result are in. LPA reviewed 3 staff files and 2 client files. LPA interviewed 2 staff and 2 clients. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report along with 2 technical assistances were reviewed and provided to licensee Danielle Norman.

met_with: Licensee- Danielle Norman


facility_name: SHEILA'S SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On the February 17, 2022 at 10: AM, Licensing Program Analysts (LPA) Babatunde Aborchie arrived at Sheila's small family home, met with licensee who granted access to the home. The purpose of this visit is to conduct an annual required inspection of the small family home. Presently there are two children (C1 and C2) in placement and one of two was not present during time of inspection (See LIC 811). The home is a single story with four bedrooms and two bathrooms. Bedroom #1 has one twin bed; it is a vacant room. Bedroom #2 has two tin beds; it is occupied by a single client C Bedroom #3 has a two twin beds; it is occupied by a single client C Bedroom #4 has a twin and a full bed; it is occupied by staff . 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. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in the dining room cabinet. Cleansers/chemicals are locked and stored in the laundry room cabinet. Sharp knives are inaccessible and stored in a locked Kitchen drawer. The first aid kit is in the dining room cabinet. There are no guns or weapons as stated by Licensee at this time. The hot water temperature was within normal limits of regulatory requirements. All facility smoke detectors and carbon monoxide detectors are synchronized and in appropriate working order; fire extinguisher is properly charged and serviced. LPA interviewed two staff and a child in the home. A review of staff records on this date indicated that all facility staff had received criminal record and child abuse index check clearances. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Exit interview was conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to Licensee.

met_with: Licensee


summary: Facility Evaluation

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Narrative:
On April 20, 2023, at 9: AM, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Sheila's small family home, met with licensee who granted access to the home. The purpose of this visit is to conduct an annual required inspection of the small family home. Presently there are two children (C1 and C2) in placement and two of two were not present during time of inspection (See LIC 811). The home is a single story with four bedrooms and two bathrooms. Bedroom #1 has one twin bed; it is currently occupied by one client; Client 1 (C1) Bedroom #2 has two twin beds; it is occupied by a one client, Client 2 (C2) Bedroom #3 has a twin bed; it is currently vacant Bedroom #4 has a twin and a full bed; it is occupied by licensee 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. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in the dining room cabinet. Cleansers/chemicals are locked and stored in the laundry room cabinet. Sharp knives are inaccessible and stored in a locked Kitchen drawer. The first aid kit is in the dining room cabinet. There are no guns or weapons as stated by Licensee at this time. The hot water temperature was within normal limits of regulatory requirements of 110 degrees. All facility smoke detectors and carbon monoxide detectors are synchronized and in appropriate working order; fire extinguisher is properly charged and serviced. LPA interviewed two of three staff. A review of three of three staff records on this date indicated that all facility staff had received criminal record and child abuse index check clearances. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Exit interview was conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to Licensee.