summary: Facility Evaluation

raw_content:
Narrative:
On 12/02/25 at 10:10 am, Licensing Program Analyst (LPA) Mona Lam conducted a continued Annual Inspection at listed facility. LPA met with Acecarmela Emata. The Group Home is licensed to serve 6 clients ages 6-17. At the time of the inspection, one staff and two clients were present. Other clients were out on their day program. LPA inspected five client files. One of the client files was missing multiple records: medical and dental history, including immunization record, written authorization of the child's parent/guardian for each psychotropic medication, signed copies of facility's policies/procedures regarding the child's removal and/or discharge; discipline; and complaints, and physician's report/written medical assessment. LPA issued a Type B deficiency under 80070(a) Client Records. LPA asked if clients shared bedrooms. Staff stated yes. LPA was unable to identify bedroom compatibility assessment. LPA issued a technical violation under 84087(e) Buildings and Grounds. LPA inspected disaster preparedness plan. LPA was unable to locate information regarding storage and preservation of medications. LPA issued a technical violation under 1565(a)(7)(E). LPA advised facility to place needs and appraisal plan with list of medications in a readily available area to take during an emergency. LPA was unable to locate fire clearance of the facility. LPA issued a technical violation under 80020(a) Fire Clearance. LPA inspected five staff files. LPA was unable to identify statement signed by staff that they are at least 18 years of age, complete job descriptions of all positions in facility, records of work performance evaluations, and facility manager training of one hour. LPA issued technical violations under 80066(a)(4) Personnel Records, 84066(b)(1) Personnel Records, 84066(b)(6) Personnel Records, 84065(d)(3) Personnel Records. LPA was identify training for staff. LPA advises facility to have training topics labeled in facility files in correspondence to training under 84065(i)(3) Personnel Records. One staff took a break and another staff covered the shift. Around 1: PM, LPA conducted two confidential interviews. One deficiency was cited at this time. An exit interview was conducted, appeal rights discussed and copy of this report was given to Joel Bustillos, whose signature confirms receipt.

met_with: Acecarmela Emata, Staff


state: CA

facility_name: MONTECITO HOMES

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
... training, and the facility administrator/licensee is a certified ProAct instructor. Based on confidential interview, staff do received in-house informal training during staff meetings, but this training is not clearly reflected in the staff training logs. Additionally, not all staff have a current training log. It is not clear if in-house training was provided to meet the annual training requirements for staff, as they are not well documented. Although the allegation may have happened or is valid, based on LPA's observations and interviews with staff, there is not a preponderance of the evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is Unsubstantiated. Due to the challenges of providing training during the pandemic, LPA is issuing a technical advisory per Title Section Personnel Records, referencing Section Personnel Requirements. An exit interview was conducted, and a copy of this report was left with Facility Manager Jomar Dela Peña, whose signature on this form confirms receipt.

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

report_type: Complaint Investigation

met_with: Facility Manager Jomar Dela Peña

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13At 1:45PM on 12/7/2022, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced complaint inspection to the facility listed above. The reason for the inspection is to notify the facility listed above. LPA met with Rod Nubla, Administratror who helped facilitate the inspection. Over the course of the investigation, LPA conducted confidential interviews and a file review for the allegation listed above. Evidence obtained revealed that the allegation of minor sustained an injury while in care is unsubstantiated. Evidence revealed that an incident took place in July of 2022 which resulted in client falling from the facility van and onto the pavement below directly on their back during a client behavior. In addition, evidence revealed that client was being seen by their physician regarding a rash that was on their back. Therefore, the allegation is unsubstantiated, meaning that although the allegation may have happened, or is valid, there is not a preponderance of the evidence to prove that the allegations above occurred. At this time, no California Code of Regulations are being cited. An exit interview was conducted and a copy of this report will be emailed to Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Karmen Balhotra LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Rod Nubla


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegations. LPA met with Jose Mario De La Pena, Lead Staff at 11: AM on 12/29/22. There were six staff and six clients at the facility. Over the course of the investigation, LPA conducted confidential interviews and reviewed files during this investigation. Based on confidential interviews conducted it was determined the client sustained bruises through self-harm. Individuals intereviewed stated that the self-harm likely occured between 2/25/22 and 2/28/22. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Jose Mario De La Pena, Lead Staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Jose Mario De La Pena, Lead Staff


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

met_with: Facility Manager George Pastera


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 7/10/24, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to deliver findings for the investigation of the above complaint allegation. LPA met with Lead Staff Joey Dela Pena and informed of the purpose of the visit. Based on confidential interviews, observations, and record review, including review of police investigation report and interviews with alleged victim and suspect, it was alleged that a staff member hit a resident with an open hand on the face. The preponderance of evidence reflects that this incident did occur. Therefore, the preponderance of evidence standard has been met, and the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Division 6, Chapter 5, Article 6, Section Personal Rights. See LIC 9099-D. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Lead Staff Joey Dela Pena. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: MONTECITO HOMESFACILITY NUMBER: 075650122

met_with: Lead Staff Joey Dela Pena

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On Friday 9/3/21 at 9:25AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Licensee Rod Nubla and informed of the purpose of the visit. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. LPA used the Inspection Tool to conduct the inspection. There are six children in care, and five children were at school. There are seven staff, and two staff are present, plus Licensee. LPA toured the facility site and observed: -- The facility site and grounds are clean, free of debris and hazards, and is well-maintained. -- Food is properly stored, is fresh and within date, and meets the 7-day nonperishable, 2-day perishable mandate to meet the needs of residents in care. The kitchen is stocked with utensils and dishware. -- Medications, sharps, and chemicals are all locked and inaccessible to residents in care. A razor was found in the cabinet in the hallway resident bathroom. Licensee stated residents are able to shave but are watched and assisted by staff, and per their care plans, no residents have self-harm behaviors involving sharp items. -- The smoke detectors were tested and are functioning. -- The first aid kit was centrally stored and contained all required items. -- Hot water and room temperature were maintained within permitted ranges, at 115. F and F, respectively. LPA inspected the facility files and observed: -- The client files are complete and contain all required documentation. Medication records are complete and indicate consistent and proper administration of medications. [Continued Next Page] -- LPA observed that the inventory of belongings were old (from 2017) and not current, or were missing. LPA advises, per California Code of Regulations (CCR), Title 22, Section 80070, that the facility update the inventories and ensure current records are maintained. -- LPA observed that the medication records were well organized, but the psychotropic medications, while logged separately, were not logged on a separate sheet. LPA advised that Licensee begin using the LIC 622B, or variation of, to log psychotropic medications. -- The staff files are complete and contain all required documentation. All staff are cleared and associated to the facility. Staff have current first aid training certificates. -- LPA observed that the training documentation does not reflect that the 20 hour annual training requirement, per CCR, Title 22, Section 84065, was met for 2020. Licensee stated that it has been a challenge to obtain training from outside agencies but training in the form of team meetings with Licensee and with behaviorist have been conducted in-house. LPA advised that Licensee develop an in-house training template to document in-house trainings. -- LPA observed that staff S1 (See LIC Confidential Names, dated 9/3/21) was cleared and associated to the sister facility also under Licensee but not to this facility. S1 works at the other facility and has only been working at this facility temporarily. However, as S1 has been working at this facility for at least a few months, LPA advises, per CCR, Title 22, Section 80019, that S1's clearance be transferred to this facility. -- The license, menu, emergency plan, and personal rights are posted in visible locations in the facility. -- LPA observed that the complaint procedures were not posted in the facility. LPA advises, per CCR, Title 22, Section 84072.2, that Licensee print and post the complaint procedures in the facility in a location visible to residents, authorized representatives, and visitors. LPA conducted resident observation and staff interviews: -- Resident present during visit appeared happy and was being engaged by attentive staff and participating in activities with staff. -- Staff are knowledgeable about the needs of residents in care, program procedures, and mandated reporter status. There are no citations. Six advisories were provided. An exit interview was conducted, and a copy of this report was left with Licensee Rod Nubla, whose signature on this form confirms receipt.

report_type: Facility Evaluation

visit_type: Annual

met_with: Licensee Rod Nubla


summary: Facility Evaluation

raw_content:
Narrative:
On 4/13/22 at 3:16PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility regarding an incident report that was submitted to the Licensing agency. LPA met with Lead Staff Jomar Delapena and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing and pre-visit screening call with Licensee Rod Nubla. During visit, LPA interviewed three staff and attempted interviews with involved residents. LPA reviewed resident records and obtained relevant resident documents and authorized representative contact information. Further investigation is needed at this time. An exit interview was conducted, and a copy of this report was left with Lead Staff Jomar Delapena, whose signature on this form confirms receipt.

visit_type: Case Management

met_with: Lead Staff Jomar Delapena


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Alyssa Ng on 5/31/2022 at 11:15AM. During the inspection, LPA Ng met with Rod Nubla, Administrator and inspected the facility inside and out. LPA reviewed 6 of child's records on site at the facility at 12: PM. LPA reviewed 3 of staff personnel files on site at the facility at 2: PM. LPA reviewed 6 of child's psychotropic medications and medication records at 12: PM. LPA interviewed 2 of staff on site at 11: AM. LPA interviewed 0 of children currently taking psychotropic medication at 2: PM. Four clients were at school and two were on a community outing. All clients are non-verbal and unable to answer or understand interview questions. Therefore, LPA did not interview clients. LPA conducted exit interview with Rod Nubla, Administrator at 2: PM. LPA provided the Summary Report to Rod Nubla, Administrator upon completion. LPA did however, issue a Technical Assistance in regards to staff document maintenance. LPA conducted exit interview and left a copy of the report with the Administrator at 2: PM.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/13/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility regarding an incident report that was submitted to the Licensing agency. LPA met with Lead Staff Jomar Delapena and Cesar Redota and informed of the purpose of the visit. An initial visit was made on 4/13/22. Based on confidential interviews with staff and LPA's observation at the facility, the residents involved in the inappropriate behavior at night while they were roommates have been separated into different rooms and are monitored by staff during the day to ensure no further inappropriate behavior, and there have been no similar incidents since. During visit, LPA observed the residents to all be engaged and interact well with each other with no evidence of any discomfort or inappropriate behavior between residents. There are no deficiencies cited. An exit interview was conducted and a copy of this report left with Lead Staff Jomar Delapena, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility.The purpose of this visit was to conduct a office visit. LPA discussed this with George Pastara, Staff Member at 11: AM on 12/20/22. There were four staff members and two clients present at time of arrival.Two other clients arrived during the inspection at a later time. The purpose of the visit was to conduct staff interviews and receive documents. LPA Simien had to wait to conduct interviews and collect documents due to the facility being inspected by Regional Center of the East Bay (RCEB). LPA Simien interviewed two staff members LPA Simien received client general info sheet, individual plan, and incident reports from school. LPA Simien traveled to Pinnacle View Way, Antioch CA on 12/20/22 at PM to attempt another staff interview. LPA Simien knocked and rang the doorbell multiple times but no one answered. LPA Simien waited 15 minutes and tried ringing and knocking again but no one answered. LPA Simien returned to the facility to finish the office visit. Exit interview was conducted and a copy of this report was provided to George Pastara, Staff Member whose signature on this form confirm receipt of these documents.

met_with: George Pastara, Staff Member


summary: Facility Evaluation

raw_content:
Narrative:
On 5.24.2023 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Rod Nubla, Administrator. Facility has census of six clients. Two clients came home at 1: PM. Safety precautions were used such as temperature reading, sanitizing of the hands, mask wearing, and social distancing. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. There were three client bedrooms and one staff bedroom. All bedrooms are double occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was 72 degrees and was maintained at a comfortable temperature within permitted range. Water temperature measured at 120.4 which is in the permitted range. Both clients who were home were non-verbal. Residents present during visit appeared happy and was being engaged by attentive staff and participating in activities with staff. LPA conducted two staff interviews. At 2: PM, LPA Ng toured the backyard. The backyard has a wooden fence. A swing set was located in the middle of backyard. A wooden gazebo was located on the side of the backyard. No open bodies or water or hazards were present. All client records complete with all of the required documentation. Each client and staff has their own separate binder of all required documents. All staff and client records were observed to be complete except for the following : -------CONTINUE TO 809C---------- LPA Ng reviewed medication logs for all six clients. LPA Ng noticed that the psychotropic medication did not have their own separate log. LPA advises per CCR regulation, 84070(b)(13), Children's Records. Please see 809D. All but one client in the home are all over 18. Clients ages are 22, 21, 21,21,19, and 17. LPA advises facility to submit a Adult Residential application. LPA advises per CCR regulation, 80010(a), Limitations on Capacity and Ambulatory Status. Administrator discussed the process of converting to an Adult Residential Facility. Administrator will let LPA know the timeline and give monthly updates. At this time, 1 deficiency was cited and a technical violation was given. An exit interview was conducted, and a copy of this report was left with Administrator Rod Nubla, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/13/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit. LPA met with Facility Manager George Pastera and informed of the purpose of the visit. During an investigation at the facility, LPA became aware of an area in which technical assistance may be beneficial. See LIC 9102 dated 2/13/24. An exit interview was conducted, appeal rights were discussed, and a copy of this report was left with Facility Manager George Pastera, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/3/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit in order to follow-up on a submitted incident report. LPA met with Administrator Rod Nubla and informed of the purpose of the visit. The incident in question is one where a resident exited the facility through their bedroom window around 2AM, and staff became aware when the resident was returned to the facility by police around 2:55AM. LPA discussed the incident with Administrator, who stated running away has been a trend in behavior for the resident at the facility and at school. The resident's quarterly care plan indicates "AWOL" is a targeted behavior. The plan does not specify a requirement for bedroom checks at night. Administrator stated they will be planning on scheduling a meeting with the resident's regional center case manager to discuss enhancing supervision, including hourly bedroom checks at night. At this time, evidence does not confirm that a deficiency or violation resulted in this incident occurring. No citations were issued at today's visit. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator Rod Nubla, whose signature on this form confirms receipt.

met_with: Administrator Rod Nubla


summary: Facility Evaluation

raw_content:
Narrative:
On 4/3/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit. LPA met with Administrator Rod Nubla and informed of the purpose of the visit. The purpose of the visit was to give notice of area(s) in which technical support may be beneficial. During an investigation at the facility, LPA observed that the medication records for a resident in care had not been updated to include a new medication in the centrally stored medication log, and a medication administration record had not been prepared for the medication. LPA reviewed the records with Administrator at today's visit. The records reflected that the medication had been administered first on 3/21/24 morning, but no records were observed on 3/21/24 around noon reflecting administration or storage of the medication. All records were complete as of today. LPA is advising that the facility ensure all staff are trained to update medication storage records upon receipt of the medication and to prepare medication administration records prior to administration. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Administrator Rod Nubla, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/8/2024 at 10:40am, Licensing Program Analyst (LPA) Selena Hood and LPA Celeste Aparicio conducted an unannounced visit to the listed facility. The purpose of this visit was to conduct an SB Psychotropic Medications inspections. LPA met with Rod Nubla, Administrator. LPAs found that the facility had no clients that met SB Psychotropic Medications inspection criteria. LPAs reviewed the locked medication and centrally stored medication binders. LPAs conducted a walk through of the facility. LPAs observed no deficiencies. LPAs conducted an exit interview with Rod Nubla, Administrator at 11:45am whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Oquendo on 5/6/21 at 12:30PM. LPA spoke with licensee - Rod Nubla, who also sent the requested file documents for review. This inspection was conducted via FaceTime due to COVID19 restrictions on conducting on-site inspections at licensed facilities. LPA viewed the medications, which were locked in a cabinet, located inside the locked staff office. Facility has a capacity of six, with one child in placement. This child is currently prescribed three psychotropic medications and is non-verbal. This facility previously received an SB 484 inspection in 2018. No deficiencies were cited during that inspection but an advisory note was issued to the licensee. LPA conducted exit interview and requested additional documents from the Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/13/22, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility to issue a citation for a deficiency observed during a visit at the facility. LPA met with Lead Staff Cesar Redota and Jomar Delapena and informed of the purpose of the visit. LPA spoke to Administrator Rod Nubla over the phone. Rod approved for Jomar and Cesar to represent facility for today's visit. Rod confirmed that Lead Staff Jomar and Cesar are not facility managers and that there was no LIC Designation of Facility Responsibility for any staff as no staff had been designated a facility manager. LPA did not observe these forms in the file. LPA is issuing a citation of Health and Safety Code 1522.4(a)(3). See attached LIC 809-D. During visit, a youth in care called 911, and staff did not respond to the emergency personnel's requests to speak to a staff member. The youth had the phone on the speaker setting, so as youth approached LPA, LPA could overhear. LPA directed staff that the speaker was requesting to speak to a staff, and staff continued to not respond. Staff did not understand LPA's direction. LPA requested the phone from the youth and spoke to the emergency personnel on behalf of the facility. Afterward, LPA spoke to staff, and staff stated that the youth has called 911 multiple times before and is to be monitored while on the youth's personal phone to ensure youth does not unintentionally call 911. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80065(a). See attached LIC 809-D. During visit, LPA toured the facility and observed there were three beds in the garage. Based on confidential interviews, all beds are being used by staff. LPA observed dressers and cabinets with staff clothing and belongings next to the beds in the garage. LPA is issuing a citation of California Code of Regulations, Section 84087(b)(4)(A). See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Lead Staff Jomar Delapena, whose signature on this form confirms receipt.


facility_name: MORADA HOME

raw_content:
Narrative:
The interviews did not prove that facility staff made inappropriate comments to C1 nor did it show that facility staff refused to feed C1. In fact C1 stated that she refused dinner that was prepared for the evening. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There are no deficiencies being cited at this time. Exit interview was conducted, Appeal Rights and a copy of this report will be mailed to Oneisha James, Facility Administrator.

Investigation Findings:
13On October 12, 2021 at 1pm Licensing Program Analyst (LPA) Donald Martin conducted a follow-up complaint inspection and spoke to Oneisha James, Facility Administrator. The purpose of the inspection was to provide findings for the above complaint allegations. During the course of investigating the allegations for facility staff physically abused group home child, facility staff made inappropriate comments to group home child and facility staff denied group home child food as a form of punishment, LPA conducted interviews. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that facility staff physically abused the group home child. The police stated that there was no physical evidence of bruising on the child during the visit. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MORADA HOMEFACILITY NUMBER: VISIT DATE: 10/12/2021

met_with: Oneisha James-Facility Administrator


raw_content:
Investigation Findings:
13On October 15, 2021 at 10: AM, Licensing Program Analyst (LPA) Charmetha White arrived at the above location for the purpose of concluding the investigation and to deliver findings on the above allegations. LPA met with Facility Administrator, Oneisha James and discussed the findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Interviews and records did not produce corroborating evidence to support the allegations. Staff denied the allegations. Staff stated they have never witnessed any staff smoking marijuana in the presence of minors. However, Staff #1 did confirm a staff was terminated for bringing marijuana to the facility. Staff stated none of the staff have ever pushed or physically abused any of the minors in care. Children interviewed stated the staff treat them fine and that staff do not push or hit them. LPA was unable to obtain a statement from Child #1 as Child was replaced and Child #1's bed was closed effective 11/07/2020. Based on information obtained, the allegation is found to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview completed and a copy of this report was left with Facility Administrator, Oneisha James. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White 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 2

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

met_with: Facility Administrator - Oneisha James


raw_content:
Narrative:
Staff #1 and Staff #2 did assist Child #1 into the home from being seated on the lawn in front of the facility, however due to rainy conditions and after hours of crisis communication. Both Staff #1 and Staff #2 are CPI (Crisis Prevention Intervention) trained and current CPI cards are attached to the report. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegation is Unsubstantiated. There are no deficiencies being cited at this time.

Investigation Findings:
13On September 19, 2024 at 2pm, Licensing Program Analyst (LPA) Donald Martin conducted a follow up complaint inspection and spoke with Facility Manager, Zerlene Graham. The purpose of this inspection was to deliver findings for the above complaint allegation. During the course of investigation the allegation for staff physically abused minor in care, interviews were conducted and documents obtained. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that staff physically abused minor in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin 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: MORADA HOMEFACILITY NUMBER: VISIT DATE: 09/19/2024

met_with: Zerlene Geraham-Facility Manager


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
A1 stole personal identifying information of approximately several individuals to file 72 fraudulent unemployment insurance and 19 fraudulent disability insurance claims from 2020 until present. A1 caused over $800,000 in unemployment insurance losses and over $200,000 in disability insurance losses to the State of California. Information obtained revealed in part that A1 pleaded guilty to fraudulently using stolen personal identifying information to file for unemployment insurance and disability insurance claims through Employment Development Department. Based on record review and confidential interviews, the preponderance of the evidence standard has been met. Therefore, the allegation that Licensee/Board member (A1) was arrested for COVID Insurance fraud and identity theft is substantiated. This poses an immediate health, safety, and personal rights risk of harm to children placed in care. The facility is issued citation in accordance with Health and Safety Code section Persons prohibited from employment; dismissal or removal. (See page LIC9099-D for cited deficiency). An exit interview was conducted. A copy of this report, and appeal rights were provided to Facility Administrator via email.

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

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

met_with: Facility Representative/Manager


summary: Facility Evaluation

raw_content:
Narrative:
On December 7, 2021 at 9:49am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Morada Home for the purpose of conducting an Annual/Required Inspection. LPA met with the licensee, Abiola Quadri who provided a tour of the facility. This facility is licensed to provide care and supervision to four (4) ambulatory, developmentally disabled male and female clients ages 7 -17 years old. The census today is three (3) clients. The home was observed to be set-up as follows: This is a single-story home located in a residential neighborhood with three (3) bedrooms, two (2) bathrooms, living room, dining area, kitchen, laundry area, detached garage, an office, and a backyard. Living Room: Is equipped with 3 sofas, a mounted TV, and a fireplace with a locked screen. Dining Area: Is equipped with a table and four (4) chairs. Kitchen: Is equipped with a stove with five (5) burners all working at this time. A microwave mounted above the stove, a dishwasher, and a refrigerator/freezer. The home was observed to have two days of perishable food and one week of nonperishable food supplies. Clients are provided nutritious snacks between meals. Trash can had a lid. Sharp knives are kept in a locked safe on the kitchen counter top. Medications that do not require refrigeration are kept in a locked kitchen cabinet. There are no clients that require refrigerated medications. Laundry Area: Is located along the hallway. There are two locked cabinets in the laundry area, one contains extra hygiene products for clients and the other contains laundry detergent and cleaning supplies. All cleaning solutions are made inaccessible to the clients. Office: Is located off the backyard and it is kept locked. The office is equipped with a desk, one (1) chair, and two (2) file cabinets. Client and staff files are stored in the office. Bedroom #1: Is occupied by Client #1 and the room is equipped with one twin size bed. The room has adequate drawers, closet space, lighting, and a window. Bedroom #2: Is VACANT and the room is equipped with one twin size bed. The room has adequate drawers, closet space, lighting, and a window. Bedroom #3: Is occupied by Clients #2 & 3. The room is equipped with two twin size beds. The room has adequate drawers, closet space, lighting, and a window. This room also contains BATHROOM #2. Bathroom #1: Is located along the hallway. Bathroom #2 is located inside of bedroom #3. Both bathrooms were checked and observed to be in good repair and working order. Continued on LIC 809-C The home is equipped with 2 regulation fire extinguishers. Smoke alarms and carbon monoxide detectors were tested and found to be in working order. The first aid kit was checked and found to be complete. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. There are no swimming pools or bodies of water on the premises. No weapons are at the facility. Overall LPA observed the home to be clean, safe, sanitary and in good repair. Passageways and open porches are unobstructed. The front and back yards were inspected and found to be clear of hazards and debris. The facility has a Grey Toyota Sienna, clean and in good repair to transport clients. Current automobile insurance is with Infinity Insurance Company. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children are not restricted in telephone use except by court order. Children can contact the licensing agency or Foster Care Ombudsman person in confidence without threats or punishment for making complaints. Children attend school, extracurricular, cultural and personal enrichment activities. Emergency Disaster Mass Casualty Plan: Current and available for review. All posting requirements were met. LPA reviewed following during the inspection: Staff Records Review: LPA reviewed six (6) staff records stored in individual personnel file/binders provided by Administrator. LPA ensured to thoroughly review the records of the primary active staff (i.e The Program Administrator, Facility Manager; and four (4) Direct Care Staff. LPA conducted a confidential interview with one (1) on duty staff. Additional confidential staff interviews will be conducted at a later date. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the three (3) clients in placement. In review of the staff's records LPA confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response. Continued on LIC 809-C LPA reviewed three (3) client records which contained copies of the Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. It was reported by Facility Manager that children attend school, extracurricular, cultural and personal enrichment activities. LPA will conduct confidential client interviews at a later date. LPA informed Administrator of licensing fees due by 12/27/2021. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80019(e)(2), Criminal Record Clearance. No transfer of staff criminal record clearance to facility. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80054(b), Penalties. Notwithstanding Section 80054(a) above, an immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed if any individual required to be fingerprinted under Health and Safety Code Section 1522(b) has not obtained a California clearance or a criminal record exemption, requested a transfer of a criminal record clearance or requested and be approved for a transfer of an exemption as specified in Section 80019(e) prior to working, residing or volunteering in the facility. An exit Interview was conducted and a copy of this report, a copy of the AMENDED 809-D to include the above citations and the civil penalty assessment-background check will be emailed to the facility.

met_with: Oneisha James - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On December 10, 2021 at 9:49am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced attempted visit to Morada Home for the purpose of conducting a Continuance Case Management Annual Required Inspection which took place on December 7, 2021. LPA rang the doorbell and there was no answer. LPA called and spoke with Oneisha James, Administrator by telephone at (323) 818-6398. Administrator stated that no one would be home until 4:30-5:00pm today. Administrator stated two (2) clients were in school and one (1) client had appointments today. Telephone call ended.


summary: Facility Evaluation

raw_content:
Narrative:
On January 18, 2022 at 2:15pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Morada Home for the purpose of a case management continuance for an annual required inspection which took place on December 7, 2021. LPA Edison rang the doorbell several times with no answer. LPA observed a gray Toyota Sienna van in the driveway of the home. LPA called and spoke with Oneisha James, Administrator at (323) 818-6398 at 2:28pm. Administrator informed LPA that no one was home. Administrator stated that the census for the day was three (3). Administrator stated that two (2) clients were at school and one (1) client was on a family visit. Administrator stated clients had appointments for a haircut after school. Administrator stated that staff was not there and that no one would be home until between 4:30pm-5:00p. Administrator requested LPA to follow up on an issue they are having with Guardian and associating staff to the facility. LPA will follow up on a later date. Telephone call ended.


summary: Facility Evaluation

raw_content:
Narrative:
On March 1, 2022 at 9:49am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Morada Home for the purpose of conducting a case management continuance of an Annual/Required Inspection which took place on December 7, 2021. LPA met with Oneisha James, Administrator who granted access to the facility. This facility is licensed to provide care and supervision to four (4) ambulatory, developmentally disabled male and female clients ages 7 -17 years old. The census today is three (3) clients. The home was observed to be set-up as follows: This is a single-story home with three (3) bedrooms, two (2) bathrooms, living room, dining area, kitchen, laundry area, detached garage, an office, and a backyard. LPA conducted one (1) staff interview. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the three (3) clients in placement. In review of the staff's records LPA confirmed that all staff has the required criminal record clearance, DOJ, FBI and Child Abuse Response. LPA will conduct client interviews on a later date. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. Children attend school, extracurricular, cultural and personal enrichment activities. Administrator was reminded to report changes in the plan of operation affecting service to clients. Emergency Disaster Mass Casualty Plan was current and available for review. Designation/staff assignments current. Facility operates within license conditions & limitations including capacity limitations. All posting requirements were met. Continued on LIC 809-C Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report will be emailed to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On July 01, 2022 at 2: PM, Licensing Program Analysts (LPA) Charmetha White made an unannounced visit to Morada Home for the purpose of Case Management visit. LPA met with CEO, Abiola Quadri and Administrator, Oneisha James. This facility is licensed to provide care and supervision to four (4) ambulatory, developmentally disabled male and female clients ages 7 -17 years old. The census today is three (3) clients. The department received an email on June 21, 2022 indicating the facility's bedroom #3 had a dead bolt and doorknob that is not single action and that the door was blocked by a night stand. This is a singe story 3 bedroom home. LPA toured the home and inspected all bedrooms. Bedroom #1: Is occupied by Client #1 and the room has two (2) exit windows. Bedroom #2: Is occupied by Client #2 and the room has two (2) exit windows. Bedroom #3: Is occupied by Client #3, the room has two (2) exit windows and French doors leading to the backyard. LPA observed the French door to have a single action lock and no doorknob. All windows are equipped with screens and are free of security bars. Additionally, LPA reviewed Client #3's file and observed the file to have a safety plan to address client's elopement. The licensee is aware that it is the licensee responsibility to know and abide by Title Regulations: The licensee shall not be prohibited by this provision from locking exterior doors and windows or from establishing house rules for the protection of clients provided the clients are able to exit the facility Per Title Section 80072(7)(A). The home is within Title 22 regulation standards at this time. There are no deficiencies cited at this time. Exit interview was conducted. A copy of this report was discussed and was emailed to the Administrator, Abiola Quadri.

met_with: CEO, Abiola Quadri


summary: Facility Evaluation

raw_content:
Narrative:
On October 11, 2022 at 10:03am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Morada Home for the purpose of conducting an Annual/Required Inspection. LPA met with Oneisha James, Administrator who provided a tour of the facility. This facility is licensed to provide care and supervision for up to four (4) developmentally disabled male and female children ages 7 -17 years old, ambulatory only. There is no pool or bodies of water on the premises. The census on today is three (3). The home is set-up as follows: This is a single-story home located in a residential neighborhood with three (3) bedrooms, two (2) bathrooms, living room, dining area, kitchen, laundry area, detached garage, an office, and a backyard. Living Room: Equipped with 3 sofas, a mounted TV, and a fireplace with a locked screen. Dining Area: Equipped with a table and four (4) chairs. Kitchen: Equipped with a stove with five (5) working gas burners. A microwave oven mounted above the stove, a dishwasher, and a refrigerator/freezer. The home was observed to have one (1) week of perishable and non-perishable food. Clients are provided nutritious snacks between meals. Trash can is equipped with a lid. Sharp knives are kept in a locked safe on the kitchen counter. Medications that do not require refrigeration are kept in a locked kitchen cabinet. There are no clients that require refrigerated medications. Laundry Area: Located along the hallway. There are two locked cabinets in the laundry area, one contains extra hygiene products for clients and the other contains laundry detergent and cleaning supplies. All cleaning solutions are made inaccessible to the clients. Office: Located in the backyard and kept locked. The office is equipped with a desk, one (1) chair, and two (2) file cabinets. Client and staff files are kept stored in the office and inaccessible to clients. Continued on LIC 809-C Bedroom #1: Occupied with one (1) client. Equipped with one twin size bed. The room has adequate drawers, closet space, lighting, and a window. Bedroom #2: Occupied with one (1) client. Equipped with one twin size bed. The room has adequate drawers, closet space, lighting, and a window. Bedroom #3: Occupied with one (1) client. Equipped with two twin size beds. The room has adequate drawers, closet space, lighting, and a window. (Bathroom #2 is located inside of Bedroom #3). Bathroom #1: Located along the hallway. Bathroom observed to be clean, sanitary, and in good working order. Bathroom #2: (Located in Bedroom #3) Bathroom observed to be clean, sanitary, and in good working order. The home is equipped with three (3) fully charged regulation fire extinguishers. Smoke and carbon monoxide detectors tested audible. First aid kit was checked and found to be complete with scissors, tweezers, thermometer, and First Aid Manual. Hot water was tested and is in a safe temperature range. The beds have comfortable mattresses, clean linens, blankets, and pillows, all in good repair. There are no weapons in the facility. Overall LPA observed the home to be clean, safe, sanitary and in good repair. Passageways and open porches are unobstructed. The front and back yards were inspected and found to be clear of hazards and debris. Emergency Disaster Plan and all other posting requirements were met. LPA reviewed following during the inspection: LPA will review staff records and conduct staff interviews on a later date. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. 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. The facility is operating within the capacity and limitations of the license. Continued on LIC 809-C LPA will conduct client interviews on a later date. LPA reviewed three (3) client records which contained copies of the Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children are not restricted in telephone use except by court order. Children can contact the licensing agency or Foster Care Ombudsman person in confidence without threats or punishment for making complaints. It was reported that children in care attend school, extracurricular, cultural, and personal enrichment activities. LPA informed Administrator licensing fees of $454.00 is due by 12/27/2022. LPA provided PIN number to Administrator to pay fees online. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview conducted, and a copy of this report will be emailed to the Administrator.

met_with: Oneisha James-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 30, 2022 at 9:44am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Morada Home for the purpose of conducting a Case Management for an Annual/Required Inspection which took place on October 11, 2022. LPA met with Oneisha James, Administrator who provided a tour of the facility. This facility is licensed to provide care and supervision for up to four (4) developmentally disabled male and female children ages 7 -17 years old, ambulatory only. There is no pool or bodies of water on the premises. The census on today is three (3). The home is set-up as follows: This is a single-story home located in a residential neighborhood with three (3) bedrooms, two (2) bathrooms, living room, dining area, kitchen, laundry area, detached garage, an office, and a backyard. Overall LPA observed the home to be clean, safe, sanitary and in good repair. Passageways and open porches are unobstructed. The front and back yards were inspected and found to be clear of hazards and debris. Facility vehicle has current California Vehicle Registration and current automobile liability insurance. Emergency Disaster Plan and all other posting requirements were met. LPA reviewed following during the inspection: LPA reviewed three (3) staff records and conducted three (3) staff interviews. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. 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. The facility is operating within the capacity and limitations of the license. Continued on LIC 809-C LPA conducted two (2) client interviews. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children are not restricted in telephone use except by court order. Children can contact the licensing agency or Foster Care Ombudsman person in confidence without threats or punishment for making complaints. It was reported that children in care attend school, extracurricular, cultural, and personal enrichment activities. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview conducted, and a copy of this report will be emailed to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dahl Larios conducted a case management inspection March 16, 2023, at 10:28 am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 3 out of 3 youth files were reviewed. 2 out of Direct Care Staff and 1 out of 3 youth were interviewed. (See the Confidential Names List, LIC 811, dated March 16, 2023). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Dahl Larios observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Abiola Quadri.

met_with: Administrator Oneisha James


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Oneisha James to conduct the annual required inspection. Facility manager Alan Martinez De Anda also assisted with the inspection which commenced at 1: PM and the following was observed. This is a three bedroom, 2 bathroom home located in a residential area of the City of Altadena. There are currently three ambulatory, male clients in care. There are no bodies of water or firearms on the premises. There are no security bars on the bedroom windows. There is a screened fireplace. Kitchen and bathroom equipment is in good condition. There is locked storage space for household cleaners and sharp knives. There is adequate food to meet Title 22 requirements. There are two fully charged fire extinguishers in the home. There are working smoke and carbon monoxide detectors throughout the home, Backyard is free of hazards. All bedrooms have fully functioning windows. The following items were posted as required: Floor plan, emergency disaster plan, notice of personal rights, notice of employee rights, employee schedule and current menu. The last disaster drill was documented as of 10/02/2023.. The facility van was inspected: Horn, tires, headlights, brake lights, turn signals, seat belts and wind shield wipers all appeared to be in good condition. Bedroom #1 has 1 bed and adequate storage space for 1 client. This room is used by client # Bedroom #2 has 1 bed and adequate storage space for 1 client. This room is used by client # Bedroom #3 has 2 beds and adequate storage space for two clients. This room is used by client # LPA reviewed all client files. LPA will return at a scheduled time to review staff files and conduct required interviews,

met_with: Oneisha James,


summary: Facility Evaluation

raw_content:
Narrative:
On April 17, 2024 at 10:00am, Licensing Program Analyst (LPA) arrived at facility for the purpose of conducting a Case Management-Other to complete an IR follow up needed inspection. LPA met with Administrator Oneisha James who granted access to facility. The SIR Follow up needed is regarding report that client was hit by Director of facility while in care. During the visit, LPA obtained copies of the following: LIC 500, client roster, behavior tracking documentation for C1. LPA conducted 1 confidential interview--details documented on LIC 812. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Oneisha James


summary: Facility Evaluation

raw_content:
Narrative:
On December 17, 2024, Licensing Program Analyst (LPA) Kenrick Ellis and Licensing Program Manager (LPM), JoAunne Griffin arrived at the above facility for the purpose of conducting an Annual/Required Inspection. LPA met with Oneisha James, Administrator who provided a tour of the facility. This facility is licensed to provide care and supervision for up to four developmentally disabled male and female children ages 7 -17 years old, ambulatory only. There is no pool or bodies of water on the premises. The census today is two. The home is set-up as follows: This is a single-story home located in a residential neighborhood with three bedrooms, two bathrooms, living room, dining area, kitchen, laundry area, detached garage, an office, and a backyard. Living Room: Equipped with three sofas, a mounted TV, and a fireplace with a locked screen. Dining Area: Equipped with a table and four chairs. Kitchen: Equipped with a stove with five working gas burners. A microwave oven mounted above the stove, a dishwasher, and a refrigerator/freezer. The home was observed to have one week of perishable and non-perishable food. Clients are provided nutritious snacks between meals. Trash can is equipped with a lid. Sharp knives are kept in a locked safe on the kitchen counter. Medications that do not require refrigeration are kept in a locked kitchen cabinet. There are no clients that require refrigerated medications. Laundry Area: Located along the hallway. There are two locked cabinets in the laundry area, one contains extra hygiene products for clients and the other contains laundry detergent and cleaning supplies. All cleaning solutions are made inaccessible to the clients. Office: Located in the backyard and kept locked. The office is equipped with a desk, one chair, and two file cabinets. Client and staff files are kept stored in the office and inaccessible to clients. LPA will conduct client and staff interviews on a later date via phone. LPA reviewed three staff records and two client records which contained copies of the Needs and Service Plans and Medical Authorizations signed by each client and their authorized representative. Clients in care are always supervised and protected. Clients are accorded dignity in personal relationships with staff and others. Clients are not restricted in telephone use except by court order. Clients can contact the licensing agency or Foster Care Ombudsman person in confidence without threats or punishment for making complaints. It was reported that clients in care attend school, extracurricular, cultural, and personal enrichment activities. Facility cited for violation of California Code Of Regulations, Title Division Six, regulation 80087(a) Buildings and Grounds. Bathroom shower utilized by clients in care was observed to have mold on the ceiling. Exit Interview conducted, and a copy of this report will be emailed to the Administrator.

met_with: Oneisha James, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/11/25, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility, for the purpose of conducting an Annual/Required inspection for the facility. LPA met with Zerlene Graham Facility Manager who granted access into the home. The LPA toured the facility both inside and out. Currently residing in the home is one client. The facility is licensed for 4 developmentally disabled male and female clients ages 7-17 ambulatory only. The home was inspected and the following was observed: This is a one-story house, with a backyard and a garage in the back. There are dual carbon/smoke alarms synched throughout the house. Entery Way: There is a closet with games, activities, client files, facility disaster plan, and disaster drills. Living Room: There is a fully charged fire extinguisher. There are 3 couches for adequate seating. There is a inoperable and covered fireplace. There is a TV and a facility lain-line for clients to use. Bedroom #1: This room is currently empty. There is a full bed with an adequate amount of pillows, blankets, and linens. There are 2 dressers and a closet. There is adequate lighting and AC. There is a working window with a proper screen. Bathroom #1: Has an operating bath tub, sink, toilet, lights, and a fan. The water temp was measured to be Degrees F. Laundry Station: There is a washer/dryer. Above are 2 locked cabinets with extra toiletries and cleaning solutions. There is also a closet with extra towels, linens, bedding, and blankets. Bedroom #2: This room is used by a client. There is a full bed with an adequate amount of pillows, blankets, and linens. There are 2 dressers and a closet. There is adequate lighting and AC. There is a working window with a proper screen. Bedroom #3: This room is currently empty. There is are 2 full beds with an adequate amount of pillows, blankets, and linens. There are 3 dressers and 2 closets. There is adequate lighting and AC. There is a working sliding door with a proper screen that leads to a patio. Bathroom #2: Has an operating bath tub, sink, toilet, lights, and a fan. The water temp was measured to be Degrees F. This is located in bedroom #3. Dinning Room: Dining table with adequate seating. Posted in this room is the activity calendar, disaster plan, facility sketch, and the client rights.There is a fully charged fire extinguisher. Kitchen: Cleaning solutions are locked under the sink. The meds are locked in a cabinet. The first aid is in a cabinet equipped with a first aid manual, bandages, scissors, tweezers, and a thermometer. The facility menu is posted on the fridge. LPA observed fresh fruit and veggies on the counter. LPA observed an adequate amount of plates, cups, bowls, and utensils. The sharps are locked in a case. The pantry is adequately stocked with non-perishables and the items are dated. The fridge and freezer is adequately stocked with perishables and the items are dated. Backyard: The backyard is clear of debris. There is a locked garage with extra supplies. There is also an office area in the back for staff. There are desks, a computer, printer, and filling cabinets for staff files. LPA will return to continue inspection including staff and client file reviews, staff and client interviews, facility file reviews, and completing the CARE Tools Checklist. Exit Interview was conducted and a copy of this report was given to the Licensee.

met_with: Zerlene Graham Facility Manager


facility_name: MORNING STAR

raw_content:
Investigation Findings:
13On 6/24/2022 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection at Morning Star and spoke with Administrator/Licensee Reggieanne Villar-Battung and Facility Manager Irma Battung. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, incident reports and records were reviewed, and confidential interviews were conducted. Based on interviews and record review, Morning Star conducted two sessions on August 19th and 20th for C1 in 2021. Other than that, Morning Star did not conduct any Applied Behavior Analysis (ABA) sessions in the facility. ABA sessions has been taken place at C1 and C2's fathers or grandmothers house. C1 and C2 have a maximum of 15 hours of ABA a week. They are currently using 6-9 hours a week. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation, Facility is not meeting minor's medical needs is found to be SUBSTANTIATED. California Code of Regulations,Title 22, Division 6 & Chapter 1, Health Related Services, 80075 (a) are being cited on the attached LIC 9099D. An exit interview was conducted, appeal rights prvoded and discussed, and a copy of this report was given to Reggieanne Villar-Battung, Administrator/Licensee. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: MORNING STARFACILITY NUMBER: 075650120

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

met_with: Reggieanne and Irma Villa-Battung


summary: Facility Evaluation

raw_content:
Narrative:
At 3:08PM, Licensing Program Analyst (LPA) Madi Fremont met with the home above over Microsoft Teams to conduct a Regional Office Meeting. The purpose of this meeting was to discuss elements of the home's Noncompliance Plan, which was initiated on 03/18/2021. LPA met with Licensee/Administrator Reggieanne Villar-Battung, who helped facilitate this inspection. Also in attendance was Licensing Program Manager (LPM) Helga Wong. Currently in care are 5 ambulatory clients. On 03/18/2021, as part of the home's Noncompliance Plan requirements, the Licensee was asked to hire a new qualified Administrator to assist with daily operations and administrative duties for a minimum of 20 hours per week. The deadline for this requirement was set as June 1, 2021. The licensee has requested an extension for this deadline due to difficulties in the hiring process. During this meeting, it was discussed that the home would be granted an extension on this deadline, now set for Monday, October 4th, 2021. The licensee will provide regular updates on their progress in fulfilling this requirement. LPA Fremont will also reach out to the licensee periodically to check in on progress and provide any needed support. While the Licensee continues the process of hiring a new administrator, they have agreed to hire a qualified consultant to come to the home for 2-3 hours every week to provide technical assistance and improve the following areas: -Administrative organization and applicable regulations -Streamlining paperwork -Day-to-day operations -Staff schedules -Staff communication with outside agencies, authorized representatives, and other staff If the Licensee is not able to hire a new administrator by the 10/04/2021 deadline, it has been discussed that the two current assistant administrators, Irma Battung and Gilbert Battung, may step in after qualifications are verified. If this is the case, the consultant mentioned above will lead training for the new administrator. At this time, no deficiencies are being cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Reggieanne Villar-Battung to be signed and returned for the home's facility file.


summary: Facility Evaluation

raw_content:
Narrative:
At 9:51AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above to conduct an unannounced Required Annual Inspection. LPA met with Administrator Reggieanne Villar-Battung, who helped facilitate this inspection. Also in attendance were LPA AmyLe Tran and Morning Star Assistant Administrator Irma Battung. Currently in care are 5 ambulatory clients. During this inspection, 0 clients and 6 staff were present in the home. 5 clients arrived as LPAs were leaving the home. LPAs toured the facility inside and out. The home is single storied, and has two double occupancy bedrooms and one single occupancy bedroom. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings, desks and chairs, and twin sized beds. Each bedroom has a closet with sliding doors for extra storage space. The home has a living room and a family room which are equipped with couches and chairs for clients. The home has a dining room with enough chairs for all clients to have meals together. The kitchen was observed to be clean and free of hazards or chemicals. The weekly menu was posted in the family room. LPAs observed at least 2 days of perishable foods and 7 days of nonperishable foods. Chemicals and cleaning supplies are kept locked in a cabinet that is inaccessible to clients. No firearms on the premises. Facility had a supply of emergency food items in the garage. All medications are kept in a locked cabinet. Facility as 3 first aid kits with all required supplies. Fire extinguisher was observed in the garage, and all carbon monoxide and smoke detectors were tested and observed to be functional. Client bathroom was clean and furnished with hygiene supplies for each client. LPAs observed extra linens in two closets in the hallway. All bathroom and kitchen faucets in use by clients were measured between 111-112 degrees Fahrenheit. Thermostat was set to 71 degrees Fahrenheit. Facility license, emergency plan, personal rights, client grievance policy, floor plan, and staff schedule are prominently posted. Sharps are kept locked and inaccessible to clients. (Continued on Lic809-c) The facility has a staff room that is kept locked and inaccessible to clients. Staff room has 3 beds for staff breaks, and a sliding glass door to the backyard that is also kept locked. LPAs toured the backyard and observed it to be free from hazards. There are two play structures which are anchored to the ground, and a sitting area in the backyard. The backyard is surrounded by a wooden fence with locked gates. Ground under the play structures is covered in tanbark for client safety if falls occur. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. The facility has a fireplace which is not in use, and has a grate as well as a couch backed up to the front to ensure clients cannot access the fireplace. Facility has comfortable furnishings, accommodations, and ample lighting. All client and staff records are complete with all of the required documentation. During this inspection, LPA obtained copies of the facility's client roster, staff roster (LIC500), staff schedule, and immunization records for 2 clients. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Reggieanne Villar-Battung.


summary: Facility Evaluation

raw_content:
Narrative:
At 1:15PM, Licensing Program Analysts (LPAs) Madi Fremont and Alyssa Ng traveled to the home above for the purpose of conducting an unannounced Case Management - Legal/Noncompliance inspection. LPAs me with Licensee/Administrator Reggieanne Villar-Battung who helped facilitate this inspection. Currently in care are 5 ambulatory clients. One client was present at the time of this inspection. The purpose of this inspection was to review the home's compliance as part of their Noncompliance Plan initiated in March 2021 (Please reference LIC9111 - Noncompliance Conference Summary dated 03/18/2021 for details). As part of this Department's review of this home's compliance, LPA asked to see the following documentation which is to be submitted upon request by the Licensing Agent per the Noncompliance Plan issued 03/18/2021: - Supervision and Staff Ratios: Administrator will document weekly hours for time performing Administrative duties and not Direct Care duties. Weekly hours will be readily available either electronically or in person upon request by Community Care Licensing (CCL). - Reporting Requirements: The licensee shall track trends and frequency of incidents through ongoing internal audit. Will be made readily available either electronically or in person upon request by CCL. - Health-Related Services: The licensee will create a monthly log of self-injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. Monthly logs will be made readily available either electronically or in person upon request by CCL. (Continued on Lic809-c) - Administration: The licensee will schedule Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. Summary of review meetings will be made readily available either electronically or in-person upon request by CCL. - Administration: The administrator will be present and working in the facility for at least 20 hours per week. Hours will be made readily available either electronically or in person upon request by CCL. Upon this request, the Licensee was unable to produce proof of compliance with the aforementioned "upon request" requirements of their Noncompliance Plan. Next, LPA Fremont inquired about missed documentation submission deadlines for the following requirements of the facility's Noncompliance Plan: - Supervision and Staff Ratios: - Updated LIC Staff Schedule every 6 months starting June 1, 2021 through June 1, 2023. - 5PM, June 1, 2021 - received during annual inspection on 06/16/2021 - 5PM, December 1, 2021 - not received - Updated 1:1 staff assignments every 6 months starting June 1, 2021 through June 1, 2023. - 5PM, June 1, 2021 - not received - 5PM, December 1, 2021 - not received - Education: - Beginning April 1, 2021 through April 1, 2023, the Licensee shall submit quarterly summaries of progress, challenges, and barriers to clients' education: - 5PM, April 1, 2021 - overdue (submitted 04/06/2021 at 12:38PM with no extension request) - 5PM, July 7, 2021 - submitted early (06/17/2021 at 11:40PM) - 5PM, October 1, 2021 - not received - 5PM, January 2, 2022 - extension requested 02/15/2022, not submitted) (CONTINUED ON LIC809-C) - Staff Training: - Beginning April 7, 2021 and continuing quarterly through April 7, 2023, the Licensee shall submit training sign-in sheets as well as training materials for all topics identified during Noncompliance Conference on 03/18/2021. - 5PM, April 7, 2021 - overdue (submitted 04/09/2021 at 5:03PM, no extension requested) - 5PM, July 7, 2021 - not received - 5PM, October 7, 2021 - not received - 5PM, January 7, 2022 - not received Upon request for aforementioned submissions, the Licensee could not provide LPAs with the requested documentation. When asked why the Licensee did not have this documentation available for review by this Licensing Agency, the Licensee stated they did not know who to submit documentation to (LPA Fremont transferred from San Bruno to San Jose Regional Office on October 1, 2021, but had informed licensee by email that any submissions, questions, or concerns could be communicated through LPA Fremont, LPM Helga Wong, LPM Zaid Hakim, or RM Nelson Martinez while the department hired a new LPA to take LPA Fremont's Place - email sent 09/30/2021, 4:01PM) Because no documentation could be produced at the time of this inspection, nor did LPA's receive any documentation submissions for the deadlines listed above, LPA Fremont could not proceed with this Noncompliance/Legal Case Management Inspection. LPA Fremont requested that all documentation listed above be provided over email no later than 5PM on Friday 02/25/2021. Licensee agreed to this deadline and stated they would requested a deadline extension before this deadline, if needed. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Reggieanne Villar-Battung, whose signature on this form confirms receupt.

met_with: Administrator Reggieanne Villar-Battung


summary: Facility Evaluation

raw_content:
Narrative:
On Friday June 17, 2022 at 10AM, San Jose Children's Residential Program Regional Manager Nelson Martinez, Licensing Program Managers (LPMs) Helga Wong and Carolyn Flynn, and Licensing Program Analyst (LPA) Madeleine Fremont conducted an in-person Regional Office meeting with Morning Star Licensee/Administrator Reggieanne Villar-Battung and Facility Manager Irma Battung. East Bay Regional Center representatives Derrick Levingston and Michael Minton joined virtually via Microsoft Teams. The purpose of this meeting was to discuss the following: - Non-Compliance Meeting conducted on 03/18/2021 where the home was placed on a two-year non-compliance plan. - Licensee/Administrator not completing or submitting their Non-Compliance Plan requirements. - The home continuing to have similar deficiencies and complaints. - The Licensee/Administrator not submitting Plans of Correction for previously-cited deficiencies. - Discussion of unprofessional conduct from the Licensee/Administrator, other facility personnel and CCL staff. - CCLD Inspection Authority - Administrative Action Through the first year of the Licensee's Non-Compliance Plan the Licensee has continued to be cited for similar issued and has not fulfilled the qualifications of their non-compliance plan. The Licensee will be referred to Community Care Licensing's Legal Department for revocation of licensure or decertification of the Administrator(s). An exit interview was conducted, and a copy of this report was sent to Licensee Reggieanne Villar-Battung, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/24/2022 at 11: AM, Licensing Program Analysts (LPAs) Alyssa Ng and Lisette Valenzuela made an unannounced case management to this facility. The purpose of the inspection was to review the facilities Non-Compliance. On 06/17/22 at 10: AM, an office meeting was held, and the facility had a plan in place, and are submitting all documents to the Department by 4: PM today. During facility visit, the following was discussed: Supervision and Staff Ratios: -LIC500 to be submitted directly to CCL every 6 months, starting June 1, 2021 through June 1, 2023. The licensee will keep an ongoing updated weekly schedule to ensure full staff coverage. Every 6 months, beginning June 1, 2021 and continuing through June 1, 2023, the licensee will submit updated staff assignments for each child requiring 1:1 supervision. -Administrator will document weekly hours for time performing Administrative duties and not direct care duties. Weekly hours will be made readily available upon request by CCL. Education: -The licensee/staff must communicate with each client's educators when requested by the school -The licensee/staff must report to school when clients are absent on the day of their absence before the session begins. -Licensee/staff must work with educators and responsible parties on their education plan and progress. -The licensee/staff must participate in IEP meetings for each client when scheduled. -Staff must be present at all times to assist with online education. -Beginning April 1, 2021 through April 1, 2023, the licensee will submit quarterly summary of progress as well as challenges/barriers to education. Staff Training: -Retrain all facility staff on providing care and supervision, personal rights, duties and responsibilities, health related services, reporting requirements, communication, providing education, ensuring the health and safety of the clients, and computer/technology/IT skills. (1 hour for each training topic). -Beginning April 7, 2021 and continuing quarterly through April 7, 2023, the licensee will submit training sign-in sheets as well as training materials for the above-mentioned topics to CCL. By June 24, 2022 at 4: PM, the licensee will submit a training timeline to CCL that includes topics, dates, and trainer information. Personnel Requirements and Duties: -The facility will hire a qualified administrator to assist with daily operations and administrative duties for a minimum of 20 hours per week. Deadline for this requirement is set as June 24, 2022 at 4: PM. Reporting Requirements: -The licensee will start evaluating unusual incidents on an individual basis to ensure that all parties are informed of incidents in a timely manner consistent with CCR 80061 - Reporting Requirements. -The Licensee will track trends and frequency of incidents through ongoing internal audit, and will make available upon request by this agency. Licensee/Administrator Reggieanne Villar-Battung agreed to submit all of the following no later than today by 4: PM. No Title 22 deficiencies were cited at today's inspection. Exit interview was conducted and a copy of the report was left with the facility.

met_with: Reggieanne and Irma Battung


summary: Facility Evaluation

raw_content:
Narrative:
On 6/24/22 at 12: PM, Licensing Program Analysts (LPA) Alyssa Ng and Lisette Valenzuela made an unannounced annual/required inspection to listed facility. The facility is licensed for six residents, and currently in placement are 5 clients. During this inspection,1 clients and 3 staff were present in the home. Later on during the inspection, the rest of the clients came back from summer school, along with three staff. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. LPA Ng toured the facility inside and out. The home is single storied, and has two double occupancy bedrooms and one single occupancy bedroom. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings, desks and chairs, and twin sized beds. Each bedroom has a closet with sliding doors for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 110 degrees F. The thermostat measured 78 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in a locked cabinet. The weekly menu was posted in the family room. The facility has a fireplace which is not in use, and has a grate as well as a couch backed up to the front to ensure clients cannot access the fireplace. LPA's observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors and fire extinguishers are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. LPA's observed extra linens in two closets in the hallway. LPA's toured the backyard and observed it to be free from hazards. There are two play structures which are anchored to the ground, and a sitting area in the backyard. The backyard is surrounded by a wooden fence with locked gates. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. ----------Cont. ON 809C------ All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Reggieanne Villar-Battung.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/24/2023 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced case management to this facility. LPA Ng met with Reggieanne Villar-Battung, Licensee & Irma Battung, Administrator who helped facilitate this inspection. Currently in care are 5 ambulatory clients. 0 clients was present at the time of this inspection. At 11: AM, 1 client returned from school. The purpose of this inspection was to review the home's compliance as part of their Noncompliance Plan initiated in March 2021 (Please reference LIC9111 - Noncompliance Conference Summary dated 03/18/2021 for details). As part of this Department's review of this home's compliance, LPA asked to see the following documentation which is to be submitted upon request by the Licensing Agent per the Noncompliance Plan issued 03/18/2021: - Supervision and Staff Ratios: Administrator will document weekly hours for time performing Administrative duties and not Direct Care duties. Weekly hours will be readily available either electronically or in person upon request by Community Care Licensing (CCL). - Reporting Requirements: The licensee shall track trends and frequency of incidents through ongoing internal audit. Will be made readily available either electronically or in person upon request by CCL. - Health-Related Services: The licensee will create a monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. Monthly logs will be made readily available either electronically or in person upon request by CCL. ---------Cont. ON 809C------------- - Administration: The licensee will schedule Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. Summary of review meetings will be made readily available either electronically or in-person upon request by CCL. - Administration: The administrator will be present and working in the facility for at least 20 hours per week. Hours will be made readily available either electronically or in person upon request by CCL. Administrator confirmed that there is no new Administrator currently working at the facility. All documents that were reviewed during the inspection were from October 2022- Present. LPA Ng reviewed: -Trends and frequency of ongoing incidents. All client documents were observed to be complete. -Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. (including quarterly summary of progress as well as challenges/barriers to education) LPA Ng reviewed all quarterly summaries that included their progress and challenges. -Monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. LPA reviewed each clients daily body checks and log of injurious behaviors. -Weekly hours for time performing Administrative duties and not Direct Care duties. Administrator Reggieanne showed LPA a log of her Administrator hours each week. -Updated staff assignments for each child requiring 1:1 supervision. LPA reviewed the "Additional Staff Person" (ASP) request and fading plan for all three clients needed 1:1 supervision. -Staff training regarding related topics. Administrator Villar-Battung showed all the staff training regarding providing care and supervision, personal rights, duties and responsibilities, health related services, reporting requirements, communication, providing education, ensuring the health and safety of the clients, and computer/technology/IT skills. -Administrator will send LPA updates with hiring process. Administrator Villar-Battung is currently consulting with other group home providers in the area. Facility has posted on job sites like Indeed and ZipRecruiter. At this time, no deficiencies were cited. An exit interview was conducted, and a copy of this report was given to Reggieanne Villar-Battung, Administrator whose signature on this form confirms receipt.

met_with: Reggieanne Villar-Battung & Irma Battung


summary: Facility Evaluation

raw_content:
Narrative:
On 04/24/2023 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced case management to this facility. LPA Ng met with Reggieanne Villar-Battung, Licensee & Irma Battung, Administrator who helped facilitate this inspection. Currently in care are 5 ambulatory clients. 0 clients were present at the time of this inspection. The purpose of this inspection was to review the home's compliance as part of their Noncompliance Plan initiated in March 2021 (Please reference LIC9111 - Noncompliance Conference Summary dated 03/18/2021 for details). As part of this Department's review of this home's compliance, LPA asked to see the following documentation which is to be submitted upon request by the Licensing Agent per the Noncompliance Plan issued 03/18/2021: - Supervision and Staff Ratios: Administrator will document weekly hours for time performing administrative duties and not Direct Care duties. Weekly hours will be readily available either electronically or in person upon request by Community Care Licensing (CCL). - Reporting Requirements: The licensee shall track trends and frequency of incidents through ongoing internal audit. Will be made readily available either electronically or in person upon request by CCL. - Health Related Services: The licensee will create a monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. Monthly logs will be made readily available either electronically or in person upon request by CCL. - Administration: The licensee will schedule Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. Summary of review meetings will be made readily available either electronically or in-person upon request by CCL. ---------Cont. ON 809C------------- - Administration: The administrator will be present and working in the facility for at least 20 hours per week. Hours will be made readily available either electronically or in person upon request by CCL. Administrator confirmed that there is no new Administrator currently working at the facility. All documents that were reviewed during the inspection were from January 2023- Present. LPA Ng reviewed: -Trends and frequency of ongoing incidents. All client documents were observed to be complete. -Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. (Including quarterly summary of progress as well as challenges/barriers to education) LPA Ng reviewed all quarterly summaries that included their progress and challenges. The behaviorist is currently working on two clients monthly reports. LPA Ng set the due date for May 1, 2023 at 4: PM. -Monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. LPA reviewed each client's daily body checks and log of injurious behaviors. -Weekly hours for time performing administrative duties and not Direct Care duties. Administrator Reggieanne showed LPA a log of her Administrator hours each week. -Updated staff assignments for each child requiring 1:1 supervision. LPA reviewed the "Additional Staff Person" (ASP) request and fading plans for all three clients needed 1:1 supervision. -Staff training regarding related topics. Administrator Villar-Battung showed all the staff training regarding providing care and supervision, personal rights, duties and responsibilities, health related services, reporting requirements, communication, providing education, ensuring the health and safety of the clients, and computer/technology/IT skills. -Administrator will send LPA updates with hiring process. Administrator Villar-Battung is currently consulting with other group home providers in the area. Facility has posted on job sites like Indeed and Zip Recruiter. Administrator showed LPA the current listing for the Administrator. At this time, no deficiencies were cited. An exit interview was conducted, and a copy of this report was given to Reggieanne Villar-Battung, Administrator whose signature on this form confirms receipt.

met_with: Reggieanne Villar-Battung and Irma Battung


summary: Facility Evaluation

raw_content:
Narrative:
On 6/20/23 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced annual/required inspection to listed facility. The facility is licensed for six residents, and currently in placement are 5 clients. During this inspection, 0 clients and 3 staff were present in the home. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. LPA Ng toured the facility inside and out. The home is single storied, and has two double occupancy bedrooms and one single occupancy bedroom. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings, desks and chairs, and twin sized beds. Each bedroom has a closet with sliding doors for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 109 degrees F. The thermostat measured 67 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in a locked cabinet. The weekly menu was posted in the family room. The facility has a fireplace which is not in use, and has a gate as well as a couch backed up to the front to ensure clients cannot access the fireplace. LPA's observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors and fire extinguishers are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. LPA's observed extra linens in two closets in the hallway. LPA's toured the backyard and observed it to be free from hazards. There are two play structures which are anchored to the ground, and a sitting area in the backyard. The backyard is surrounded by a wooden fence with locked gates. Facility is in the process of taking down a play structure due to the clients getting older. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Reggieanne Villar-Battung.