raw_content:
Narrative:
On March 20, 2025, at 2:30 p.m. Licensing Program Analyst (LPA), Elena Gonzalez-Soto, arrived unannounced at the facility to obtain additional documentation for a complaint investigation related to the above allegations. LPA requested the following documents for review: six staff files of, Ongoing training log, 40-hour Facility Reliability Training Log, and signed essential job duties . No concerns were noted and training documentation reported staff took applicable training in foster youth personal rights. Confidential interviews were conducted with six individuals, and attempted with two individuals, during the period of 01/08/2025 to 04/24/2025. Interviews with LC, S2, S3, C1, C2, and C3 disclosed that no staff hit youth in care and supervision is adequate. LPA's interviews conducted, and records reviewed were consistent that facility staff do not threaten youth, slap youth, nor provide inadequate supervision of youth in care . Based on LPA interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with and a copy of this report was issued to John Tarawali, Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Elena Gonzalez-Soto conducted an unannounced complaint inspection with the above facility on 04/25/2025 at 12:50 p.m. and met with John Tarawali, Administrator. The purpose of the inspection was to deliver complaint findings for the above allegations. On January 15, 2025, at 2:05PM Licensing Program Analyst (LPA), Kayla Green, arrived unannounced at the agency for the purpose of initiating a complaint investigation related to the above allegations. LPA met with John Tarawali Administrator. LPA requested the following documents for review: Client Roster, Staff Roster and Schedule, Needs and Services Plan, CFTS notes/Preservation Plan, Personal Belongings and Inventory Log, Safety Plans, Incident Reports for three youth in care for the last three months. No concerns noted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Elena Gonzalez-Soto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 04/25/2025

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

met_with: John Tarawali, Administrator


state: CA

facility_name: HOUSE OF SULAIMAN, THE

summary: Facility Evaluation

raw_content:
Narrative:
On 3/2/ Licensing Program Analyst (LPA) Jean Stidman met with John Tarawali, Administrator, for the purpose of a Pre-Licensing Inspection. LPA inspected the facility inside and outside. LPA observed the facility is a three-bedroom, two-bathroom single story home. The facility has chemicals and sharp utensils inside locked cabinets in the kitchen. The facility will store client files and client medications inside locked cabinets in the kitchen. The facility has two fire extinguishers recently purchased. The facility has four working smoke detectors, one working carbon monoxide detector. The facility has at least a seven-day supply of non-perishable food. The facility has kitchen pots and pans, dishes, glasses, and utensils for at least three clients. Provisional License is granted.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: John Tarawali, Administrator,


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 2/28/ Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 2/28/23 at 1:45PM. During the inspection LPA met with John Tarawali, Administrator who assisted with the inspection. LPA Stidman conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection 2 staff and 1 client were present. Number of staff interviewed _1_ LPA observed the facility is a single story home with 3 bedrooms and 2 bathrooms. LPA Stidman inspected the Physical Plant has: Posting of license_X__ Personal Rights_X Disinfectants/Cleaning solutions inaccessible_X_ Refrigerator Temperature at or below 45 degrees F _ Freezer Temperature at or below 0 degrees__-4_ Nonperishable Foods one week and fresh perishable foods two days minimum_X_ Menu present and posted__X_ Working telephone _X_ Carbon monoxide detectors __X__Smoke Detector _X_ Common Room available_X Dining area (enough seating, furniture good condition, not broke or damaged) _X_ Medication centrally stored, locked/inaccessible _X Office (locked and privacy) _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_105__ Fire Extinguisher (note inspection date) _03/2/22__ Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _X__ Soap and Paper towels _X__ Laundry Facilities(available, work assign dates) __X__ Bedrooms-required linen and furnishings __X_ Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts_N/A__ Facility free of vermin _X__ Locked Facilities (open locked storage area/building/sheds) N/A. Bedroom (required bedding/furniture, furniture in good repair) _X____ LPA observed the backyard fence on the left side of the house (as you are facing the house) is leaning over/falling down. LPA reviewed five staff files and two client files. Continued on LIC809C Facility cited violation of California Code of Regulations Title 22 regulation 80087(a) Buildings and Grounds due to the backyard fence is leaning over/falling down and 84070(b)(13) Children's Records due to one client is missing immunization record An exit interview was conducted with John Tarawali, Administrator and a copy of this report was left with John Tarawali, Administrator.

Deficiencies:
80087(a): Deficient Practice Statement
1
2
3
4

visit_type: Annual

title:
80087(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by

description:
Deficient Practice Statement
1
2
3
4


summary: Facility Evaluation - 3 deficiencies

raw_content:
Narrative:
On 3/7/ Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on at 8:30am. During the inspection LPA met with John Tarawali, Administrator who assisted with the inspection. I. Operations Complaint Procedures For Youth Reviewed _X_ Board Minutes N/A CQI Report Reviewed _N/A II. Disaster Preparedness Disaster and mass casualty plan updated and available X_ Quarterly Drills conducted and documented_X_ Disaster preparedness supplies verified _X_ III. Emergency Intervention Review of manual restraint log N/A Staff training _X_ IV. Staffing/Volunteers Number of Staff files reviewed __5_ Criminal record clearances verified _5_ First Aid Certificate__3_ Certified Administrators certificate valid and current_1__ Job title/qualification verified _5__ Hours required training verified__X__ Hours required annual training verified __N/A_ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulations: 84065(b)(1)(A) Personnel Requirements. Based on records reviewed the facility is missing staff member trained in the Reasonable and Prudent Parent Standard (RPPS) 84065(i)(3)(M) Personnel Requirements. Based upon records reviewed the facility staff are missing training on the oversight and monitoring of psychotropic medications. 80075(f) Health Related Services. Based upon records reviewed two out of five staff are missing First Aid training. V. Client Records Number of Clients files reviewed _2_Needs and Services Plan (IPP) _2_ Centrally Stored Medication and log reviewed _x__ JV Reviewed _1_ Psychotropic Medication and log reviewed _2_ Cash Resources__2__ Compatible Assessment__2_ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 84070(c)(3) Children's Records. Based upon client records reviewed one out of two client files are missing the immunization record. An exit interview was conducted with John Tarawali, Administrator and a copy of this report was left with John Tarawali, Administrator.

Deficiencies:
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present
16501.4(d): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in five out of five staff files are missing documentation of trainig on oversight and monitoring of psychotropic medications which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
1
2
3
4
80075(f): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in two out of five staff (S1 & S2) files are missing documentation of training in first aid which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
1
2
3
4

visit_type: Case Management

title:
of the Welfare and Institutions Code;

This requirement is not met as evidenced by

title:
Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on 03/06/24 at 10:07 am. During the inspection LPA met with John Tarawali Licensee who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. LPA inspected and/or reviewed the following: Currently there was no staff or client present, as clients are in school and staff don't start until after 2PM. LPA observed the facility is a single story home with 3 bedrooms and 2 bathrooms. LPA Green inspected the Physical Plant has: Posting of license_X__ Personal Rights_X Disinfectants/Cleaning solutions inaccessible_X_ Refrigerator Temperature at or below 45 degrees F _ Freezer Temperature at or below 0 degrees__-4_ Nonperishable Foods one week and fresh perishable foods two days minimum_X_ Menu present and posted__X_ Working telephone _X_ Carbon monoxide detectors __X__Smoke Detector _X_ Common Room available_X Dining area (enough seating, furniture good condition, not broke or damaged) _X_ Medication centrally stored, locked/inaccessible _X Office (locked and privacy) _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_110__ Fire Extinguisher (note inspection date) _03/01/24__ Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _X__ Soap and Paper towels _X__ Laundry Facilities(available, work assign dates) __X__ Bedrooms-required linen and furnishings __X_ Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts_N/A__ Facility free of vermin _X__ Locked Facilities (open locked storage area/building/sheds) N/A. Bedroom (required bedding/furniture, furniture in good repair) _X____ LPA observed the backyard and front yard and saw nothing of concerning. LPA reviewed three client files. Annual Inspection will continue at a later date. Exit interview conducted and a copy of this report left at the facility with John Tarawali Licensee.

met_with: John Tarawali- Administrator


facility_name: HQ CHILDREN SERVICES INC

summary: Facility Evaluation

raw_content:
Narrative:
On October 4, 2022, Licensing Program Analysts (LPAs) Vanessa Galvan and Lidia Tinoco traveled to HQ children Services. The purpose of the visit is to conduct a pre-licensing Facility Inspection. LPAs were met at the facility by Carlos Hernandez, Umer Qureshi, and Jennifer Garcia. LPAs toured the facility and observed the following listed below. 1. The facility has a staff room and is inaccessible to clients. In the staff room is where medication, sharps/knives, and client files are locked and stored. 2. In the hall closet is where chemicals, disinfectants, and cleaning products are stored in a lock closet inaccessible to clients. 3. In the kitchen LPAs observed a fire extinguisher, first aid kit including all required items and first aid manual are included in the kit. The facility maintained a trash can with a lid in the kitchen. LPAs observed a weekly menu for clients. The refrigerator temperature is 37 degrees and freezer temperature are -1 degrees. 4. The dining room has a table with chairs to accommodate the number of clients. 5. The house has four bedrooms- four ambulatory, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with fire alarms and trash can. 6. The facility has adequate storage space and furniture. 7. The outdoor space has plenty of outdoor space and equipped outdoor furniture. No hazards were observed at the outdoor space. 8. The outdoor of the home was free from hazard and obstructions. Continued on Page 2... 9. Adequate food storage space observed. Perishable and non-perishable foods will be available before client are placed in the facility. 10. Facility has two full restrooms, and all are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees. All restrooms are stored with hand soap, toilet paper, and paper towels. 11. Appropriate forms posted in the facility. 12. The temperature of the facility was a comfortable temperature of 76 degrees. 13. Facility has extra towels and linens for all clients. 14.The facil ity does not have a firearm or ammunition. Fire clearance has been received from the Stanislaus Consolidated Fire Protection. Overconcentration clearance has passed the time frame for county response. Agency will make sure all staff receives a background clearance with FBI, CAIC, and DOJ and are associate in Guardian.


summary: Facility Evaluation

raw_content:
Narrative:
On October 12, 2022, a virtual Technical Assistance (TA) was conducted by Licensing Program Analysts (LPAs) Vanessa Galvan and Briana Placencia with Licensee Carlos Hernandez for HQ Children Services Group Home. The purpose of the TA was to discuss the second review letter and updates made to the application and program statement. Below is a list of items discussed with the Licensee: The licensee will associate current and new staff to the facility in Guardian. All current and new staff will receive a background clearance with the FBI, DOJ, and CAIC. Resubmit the original copy of LIC 200 with wet signatures designating Carlos as the Administrator. Mail original LIC 200 with wet signatures to E. Shaw Fresno, CA 93710. Before placement of any clients- the facility must be staffed appropriately to meet the staff/client ratio and client's behavioral needs. A updated LIC 500 will be submitted to the department once the facility is staffed. The final copy of HQ Children Service's Program Statement will be submitted to LPA Galvan, completed with the table of contents and page numbers. A copy of this report was provided to Carlos Hernandez.

met_with: Carlos Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On 03/17/2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to HQ Children Services in Riverbank, CA to conduct a post-licensing inspection. The facility was licensed on November 4, 2022. LPA were met at the facility by Administrator Carlos Hernandez. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. A facility has one van and is in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed two client and two staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, one House Manager, and six Direct Support Professional. There were no deficiencies or citations issued today. A copy of this report was left with Carlos Hernandez at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/01/2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to HQ Children Services in Riverbank, CA to conduct a post-licensing inspection. The facility was licensed on November 4, 2022. LPA were met at the facility by Administrator Carlos Hernandez. A physical plant inspection was completed and included the following observations and checks: The facility was inspected inside and out. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. A facility has one van and is in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed four client and four staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances A review of client files indicated that all required forms, reports, and documents were present. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, five House Manager/Lead, and five Direct Support Professional. There were no deficiencies or citations issued on today's inspection. A copy of this report was left with Stella Hernadez at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/26/2024, Licensing Program Analysts (LPAs) Vanessa Galvan and Melissa Renovato traveled to HQ Children Services in Riverbank, CA to conduct an Annual/Required inspection. The facility was licensed on November 4, 2022. LPAs were met at the facility by Administrator Efrain Vigil and Licensee Carlos Hernandez. A physical plant inspection was completed and included the following observations and checks: The facility was inspected inside and out. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPAs observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. A facility has one van and is in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPAs reviewed three client and five staff files. LPA interviewed 3 staff members. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances A review of client files indicated that all required forms, reports, and documents were present. Agency staff meet requirements of respective job descriptions. Agency Employs Administrator, House Manager/Lead, and Direct Support Professional. There were no deficiencies or citations issued on today's inspection. A copy of this report was left with Efrian Vigil at the conclusion of the inspection.

met_with: Efrain Vigil and Carlos Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Briana Placencia on August 7, 2025 at 10:45am. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Efrain Vigil, Administrator and inspected the facility inside and out. LPA reviewed 1 child's records and 2 staff personnel files on site at the facility. LPA reviewed 1 child's psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA attempted to interview 1 child currently psychotropic medication. LPA provided a copy of the licensing report to Administrator, Efrain Vigil. No deficiencies are being cited at this time. LPA conducted an exit interview with Efrain Vigil, Administrator.

met_with: Efrain Vigil


summary: Facility Evaluation

raw_content:
Narrative:
On November 6, 2025, Licensing Program Analyst (LPA) Vanessa Galvan traveled to HQ Children Services in Riverbank and met with the Administrator, Efrain Vigil and Facility Manager, Nancy Sanchez. A physical plant inspection was completed and included the following observations and checks: The facility was inspected inside and out. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke and carbon dioxide detectors are in appropriate working order, and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with a large table and chairs to accommodate all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms accommodate all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restrooms in operable condition. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. The facility has one van and is in safe operable condition and provides adequate seating for all clients. There are no firearms or weapons allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed four clients and five staff files. LPA interviewed 2 staff members. LPA reviewed the facility's LIC. 500. LPA confirmed the eleven staff listed on the LIC. 500 had clearances on Guardian, the review was conducted on 11/06/2025. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, three House Manager/Leads, and eight Direct Support Professionals. A review of client files indicated that all required forms, reports, and documents were present. There were no deficiencies or citations issued on today's inspection. This report was discussed, and a copy of this report was provided to Efrian Vigil at the conclusion of the inspection.

met_with: Efrain Vigil and Nancy Sanchez


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2026, Licensing Program Analyst (LPA) Vanessa Galvan, Licensee Carlos Hernandez and Administrator Efrain Vigil met for a Component III Orientation. The purpose of the Component III Orientation was to review the Group Home Rules and Regulations, prepare Licensee to maintain and operate their facility, and provide information to avoid potential problems areas. The following was addressed and discussed: Group Home and General Regulations. Safeguards for Cash Resources, Personal Property, and Valuables, Bonding, Finances, Accountability. Reporting Requirements, Emailing Incident Reports to the CCLD Inbox Fresno. Administrator & Social worker- Qualifications and Duties, Personnel Requirements, Personnel Requirements, Criminal Record Clearance. Admission Agreements, Participants Medical Assessment, Register of Clients, Personal Rights. Telephones, Transportation, Health Related Services, Food Services, Responsibility for Care & Supervision, Activities, Building and Grounds. Inspection Authority of Licensing Agency, Department Approval for Remote Site Model, Waivers and Exceptions. Complaints and the LPA, Deficiency Types, Extension Request, Types of Civil Penalties, Providers Information Notices (PINs), Complaint and Regulatory Enforcement CARE Tools, Officer of the Day, TSP Services. This report was discussed and provided to Efrain and Carlos at the conclusion of the meeting.


facility_name: I AM SAFE, INC.

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Interviews produced no witnesses or corroborating evidence to support the alleged as details of said abuse while in care, was not identified. C1 denied anyone touching C1 inappropriately, C1 did not provide any details of what was reported, and C1 did not remember any details of the facility staff or the staff's name. A review of records indicated C1 has a history of making false allegations and/or fabricating stories. Based on the above information and documentation provided, there is not enough evidence to support the allegation. Therefore, the allegation of sexual abuse is deemed Unsubstantiated at this time, meaning although the allegation may have happened or may be valid, there is not a preponderance of the evidence to support the alleged or that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted with Facility Representative/Administrator, Jesse Ayala via telephone, a copy of this report, the Confidential Names List LIC811 and appeal rights were provided to Licensee via email.

Investigation Findings:
13On December 28, 2021 at 11: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Facility Representative to discuss the investigative outcome. The investigation was conducted by Licensing Special Investigator Laura Garcia of the Community Care Licensing (CCL) Investigations Bureau. On July 19, 2021, CCL received an allegation that former Client #1 (C1) (see LIC811, dated 12/28/2021) was an alleged victim of Sexual Abuse by Former Group Home Staff member #1 (S1) and by an unknown perpetrator while in care. On July 21, 2021, LPA Regina Martin initiated the investigation and requested former client's records (Needs and Services Plan). Investigator Garcia completed the investigation which included confidential interviews of C1, assigned case social worker, Therapist, Licensee, contacts with collateral outside agencies, and review of client records and file history. (Continued on page 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina 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 El Segundo, CA Facility Name: I AM Safe, INC.FACILITY NUMBER: VISIT DATE: 12/28/2021

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

report_type: Complaint Investigation

met_with: Facility Representative Brenda Martin

complaint_status: unsubstantiated


facility_name: I AM SAFE, INC. #2

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
All the clients and several staff were interviewed and each verbal person denied that any of the allegations ever occurred. 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 left at the facility.

Investigation Findings:
13On June 23, 2021 at 4pm Licensing Program Analyst (LPA) Donald Martin conducted a follow-up complaint inspection and spoke to Ray Jackson, Facility Administrator. The purpose of the inspection was to deliver findings for the above complaint allegations. During the course of investigating the allegations for Administrator yells at residents, Administrator encourages residents to hit other residents, facility staff are out of ratio, and facility staff taught resident to restrain other residents, interviews were conducted. The interviews did no produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegation occurred. 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 El Segundo, CA Facility Name: I AM Safe, INC. #2FACILITY NUMBER: VISIT DATE: 06/23/2021

met_with: Ray Jackson-Administrator


raw_content:
Narrative:
Facility cited for violation of California Code of Regulations, Title Division Six, regulation Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. 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 the facility.

Investigation Findings:
13On June 24, 2021 at 4pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint allegations. During the course of investigating the allegations for staff strangled minor, staff hit minor and staff made inappropriate comments towards minors , 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 staff hit a minor or that staff made inappropriate comments towards minors. There was no evidence that staff strangled a minor, however it was revealed that the staff did put her hands on a minor to redirect him. The staff was terminated for this action. This will be addressed as a Case Management. 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/08/2021 and conducted by Evaluator Donald C Martin COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:I AM SAFE, INC. #2facility Number: Administrator:jones, Cedricfacility Type: Address: W. 63RD STREETTELEPHONE: (323) 531- CITY:LOS ANGELESSTATE: CAZIP CODE: CAPACITY:4CENSUS: 2DATE: 06/24/ UNANNOUNCEDTIME BEGAN: 04: PM MET WITH:Ray Jackson-CEOTIME COMPLETED:05: PM 9Staff not reporting incidents INVESTIGATION FINDINGS: 13On June 24, 2021 at 4pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint allegations. During the course of investigating the allegation for staff not reporting incidents, LPA conducted interviews. The allegations were not reported by Special Incident Report to Community Care Licensing and the interviews proved that several incidents that occurred prior to this complaint at the facilities are not being reported in a timely manor. As a result, the allegation for staff not reporting incidents is Substantiated. SubstantiatedEstimated 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: 3 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 El Segundo, CA Facility Name: I AM Safe, INC. #2FACILITY NUMBER: VISIT DATE: 06/24/2021

met_with: Ray Jackson-CEO


raw_content:
Narrative:
Confidential interviews obtained revealed that former resident, Youth #1's (Y1) roommate (Y2) at the I am Safe #2 group home, orally copulated Y1 while in care. Youth #1 did not disclose this incident to licensee or facility staff; however, Y1 was overheard telling an outside party about the incident. The Los Angeles Police Department (LAPD) conducted a sexual assault response (SART) exam of Y1 which revealed "no findings" or evidence of sexual abuse. Confidential interviews of clients and staff members further revealed no witnesses to the alleged, as statements obtained found denial observing Y2 behave inappropriately towards Y1 or towards other clients/residents in the facility. The investigation determined no witnesses to corroborate the incident. Based on gathered information obtained and reviewed, the findings are determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations, Title 22, cited at this time. Exit interview conduced. Appeal rights are discussed. A copy of this report was provided to Licensee.

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

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

met_with: Ray Jackson, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2022 at 3pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Required Facility Inspection. LPA was met by Administrator, Jessie Ayala and allowed into the facility. The facility appeared to be clean and in good condition. The visit went as follows: Living room: Spacious with furniture in good repair. Two computers and a printer for clients use. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order and also had a portable air conditioner near the window. There are two bathrooms for clients use. both contain showers and sinks. The bathrooms were clean and in good repair. Bedroom #2: There was a client present in the room upon arrival. The bedroom Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains clients medications and extra hygiene supplies and sharps. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Cont 9099-C Backyard: Is very spacious and was clean and in order at the time of the visit. Contained two large sheds one of which stays locked and is inaccessible to the clients and the other one is used for storage items. This shed stays locked as well. There is an open covered area used for parties and cookouts. Van: Was clean and in good working condition. The registration and insurance was up to date. Administrator was advised to keep a first aid kit in the vehicle. LPA will return to review facility, client and staff files. There were no deficiencies cited at the time of the visit.

met_with: Jessie Ayala-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2022 at 10am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Required Facility Inspection. LPA was met by Tisha Clemons, Facility Manager and allowed into the facility. The facility appeared to be clean and in good condition. The visit went as follows: Living room: Spacious with furniture in good repair. A computer and a printer for clients use. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order and also had a portable air conditioner near the window. There are two bathrooms for clients use. both contain showers and sinks. The bathrooms were clean and in good repair. Bedroom #2: The bedroom Contained two beds, one large dresser and two closets that contained enough clothing supply for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains extra hygiene supplies and sharps. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Cont 9099-C Backyard: Is very spacious and was clean and in order at the time of the visit. Contained two large sheds one of which stays locked and is inaccessible to the clients and the other one is used for storage items. This shed stays locked as well. There is an open covered area used for parties and cookouts. There is new workout equipment for the clients. Van: Was clean and in good working condition. The registration and insurance was up to date. Administrator was advised to keep a first aid kit in the vehicle. LPA will return to review facility, client and staff files. There were no deficiencies cited at the time of the visit.

met_with: Tisha Clemons-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On February 21, 2024 at 10am Licensing Program Analyst, (LPA) arrived at the above facility for the purpose of conducting an Annual inspection. No one is at the facility. LPA has contacted the Administrator Jessie Ayala. LPA called the number associated with the facility. The number is disconnected. LPA called a number from an old emai. The phone just rang. No voicemail is attached to the number. LPA sent an email to Jessie Ayala to contact LPA. No response. LPA will return in an hour. LPA returned to the facility. No one is at the home. On February 29, 2024 at 2:30pm Licensing Program Analyst (LPA) arrived at the above facility for the purpose of conducting an Annual inspection. LPA was met by Facility Manager, Tisha Clemons and allowed into the facility. The home is licensed to care for 4 clients 12-17 ambulatory only. The layout of the home is as follows: Living room: Spacious with furniture in good repair. Two computers and a printer for clients use. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order and also had an air conditioner in the window. There are two bathrooms for clients use. both contain showers and sinks. The bathrooms were clean and in good repair. Bedroom #2: The bedroom Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Cont 9099-C Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains sharp knives and forks. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Backyard: Is very spacious and was clean and in order at the time of the visit. Contained one large shed which stays locked and is inaccessible to the clients. There is an open covered area used for parties and cookouts. There is workout equipment for the clients. Van: Was clean and in good working condition. The registration and insurance was up to date. There were no deficiencies cited at the time of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On February 28, 2025 at 8:30am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Required Facility Inspection. LPA was met by Administrator, Jessie Ayala and allowed into the facility. The facility home is licensed to serve 4 clients ages 12 to 17 years of age, ambulatory only and Non-Minor dependents. The facility appeared to be clean and in good condition. The visit went as follows: Living room: Spacious with furniture in good repair. Two computers on two separate desks and a printer for clients use. There is an additional computer in front of the couch. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough space for two clients. Room was clean and in order and also had a portable air conditioner near the window. There are two bathrooms for clients use. The bathrooms were clean and in good repair. Bedroom #2: The bedroom Contained two beds, two dressers and two closets that contained enough space for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains clients medications and extra hygiene supplies and sharps. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Cont 9099-C Backyard: Is very spacious and was clean and in order at the time of the visit. Contained two large sheds which stays locked and is inaccessible to the clients. There is an open covered area used for parties and cookouts. There is workout equipment for the clients. Van: Was clean and in good working condition. The registration and insurance was up to date. There were no deficiencies cited at the time of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On June 24, Licensing Program Analyst, LPA Donald Martin completed a Case Management inspection to above facility for the purpose of concluding an investigation. LPA met with Ray Jackson. The Complaint Report dated April 8, 2021 disclosed that Staff #1 strangled Child #1. Interviews and documentary evidence did not corroborate that Staff #1 strangled Child #1. During the investigation process, LPA conducted interviews and reviewed Special Incident Report. Statements were consistent that Staff #1 was observed placing her hands-on Child #1 shoulders, near his neck and redirecting him to his bathroom. Staff was suspended and an internal investigation was completed. Internal investigation determined that statements were credible, and Staff #1 inappropriately placed her hands-on Child #1. Staff #1 employment with the facility was terminated. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80022 - Plan of Operation (k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.


summary: Facility Evaluation

raw_content:
Narrative:
On May 14, 2026 at 10: AM Licensing Program Analyst (LPA) Erika Butler-Williams and (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Case Management to make sure that the adult client has left the home. LPA was met by the Director Ray Jackson and allowed into the facility. C1 departed from the facility on March 14, 2026 to live with his biological Mother. No deficiencies cited at the time of the inspection.

met_with: Ray Jackson


facility_name: IHEART LIVES INC

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPAs) Kellie McKinley and Maie Soliman conducted an announced Pre-licensing inspection on 3/25/2025 at 9: AM at the above location, as required for the Group Home (GH) licensure. LPAs met with Annalyn Artadi- Licensee. During the pre-licensing visit, LPAs conducted a Health and Safety inspection using the CARE tool. LPAs observed the facility was clean inside and safe. The outside of the facility has a pool in the back yard that is fully enclosed with a five-foot fence and locking gates. There is a pool house with pump inside. The facilities sits on city property, which also is fenced and enclosed. LPAs observed that there are two floors to the facility. LPAs observed four of client bedrooms, equipped with appropriate furniture, bedding, and supplies for clients. Sufficient storage space for client's personal belongings was observed in each room. The facility is requesting to be licensed for four clients. Staff will include eight to ten staff hired and ready for the first clients ranging in age from seven to 17 years old. LPAs observed a medication Lock box in the kitchen, which was empty, but locked, and accessible only to designated staff. The kitchen area was equipped with an adequate amount of utensils, dining supplies, and cups for clients. No food was observed as there are no clients, and no pending placements at this time. Facility will verify required food on hand at time of client placement. LPAs observed a staff office space that is locked and inaccessible to clients upstairs, it will be utilized as the staff office for storing inaccessible medications and chemicals, in addition to any other item required to be inaccessible to clients. The staff office has a small fridge that will be dedicated to medications if needed. The facility has an attached garage space which houses a freezer for extra food storage and cabinets with locks for supplies which is inaccessible to the clients at all times. LPAs observed a gas fireplace in the living room with a glass barrier. continued on 809_C page The smoke detectors and carbon monoxide detectors are hard wired and were inspected by the fire department on 2/12/2025. LPAs tested another carbon monoxide detector and found it to be working. A fully equipped first aid kit was reviewed and is placed in the staff office. The Foster Youth Bill of Rights was posted in a conspicuous location. There are 2 bathrooms in the facility that are accessible to clients use. The water temperature was tested and found to be 120 degrees. The facility is ready for licensure as an Group Home and LPAs recommend that the facility be licensed. A signed copy of this report was provided to Annalyn Artadi - Licensee.

met_with: Annalyn Artadi - Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Maie Soliman made an unannounced post licensing inspection on 3/3/2026 at 10: AM. During the inspection LPA met with Annalyn Artadi, Administrator who assisted with the inspection. LPA Soliman conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection is 2:1. LPA observed four bedrooms, three bathrooms and one office. LPA Soliman inspected and/or reviewed the following: I. Physical Plant Posting of license_X__ Personal Rights___X__ Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F __X___ Freezer Temperature at or below 0 degrees__X___ Nonperishable Foods one week and fresh perishable foods two days minimum__X_ Menu present and posted___X___ Working telephone ___X____Carbon monoxide detectors __X_Smoke Detector __X___ First Aid Kit fully stocked__X__ Common Room available___X__ Dining area (enough seating, furniture good condition, not broke or damaged) ___X___ Medication centrally stored, locked/inaccessible __X___ Office (locked and privacy) ____X___ Hot Water between 105-120-degree F (Properly labeled if over 125 degree F___X___ Fire Extinguisher (note inspection date) ___April 2025__Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature ___X____ Soap and Paper towels ___X___ Laundry Room __X___ Bedrooms-required linen and furnishings ___X___ Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts__X___ Facility free of vermin __X___ Locked Facilities (open locked storage area/building/sheds) ___N/A___Bedroom (required bedding/furniture, furniture in good repair) __X__ II. Client Records Number of Clients files reviewed ___One___Needs and Services Plan __One__ Centrally Stored Medication and log reviewed _Three__ JV Reviewed _One_ Psychotropic Medication and log reviewed ___Three__Cash Resources__Three__ LPA Soliman will return on a later date to complete the inspection. An exit interview was conducted and a copy of this report was left with Annalyn Artadi, Administrator.

met_with: Annalyn Artadi, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 4/14/2026 at 11 am Licensing Program Analyst (LPA) Maie Soliman arrived unannounced at the facility for the reason of following up on a post licensing inspection. LPA met with Annalyn Artadi, Licensee who assisted with the inspection. On April 1, 2026, the LPA conducted a continuation of the post-licensing inspection. Due to a system error, not all deficiencies were generated. LPA Soliman informed the licensee prior to departure that she would return at a later date to issue the remaining LIC citations. On today's date LPA issued two Type B citations CCR 84065(f )(1) and 84065(b) and one Technical Violation 84065(f)(1) (TV), all dated 4/1/2026. An exit interview was conducted and a copy of this report was left with Annalyn Artadi Licensee.

met_with: Annalyn Artadi, Licensee


raw_content:
Narrative:
During the period of 01/15/2026 and 03/30/2026 confidential interviews were conducted with six individuals (RP, C1, S1, S2, S3, CSW) Based on LPA observations during three visits conducted on January 15, 2026, March 3, 2026, and April 1, 2026, no malodorous odors were detected within the residence or in the vehicle used to transport residents. During the visit on January 15, 2026, the LPA detected the odor of marijuana while outside on the street; the source appeared consistent with a neighboring residence rather than the facility. Additionally, during interviews conducted by the LPA, five out of six interviewees stated they had not smelled marijuana or any other unusual odor within the home. There is no evidence to support that smoking occurs within the residence. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report was left with Annalyn Artadi, Licensee.

Investigation Findings:
13Licensing Program Analyst (LPA) Maie conducted an unannounced complaint inspection with the above facility on 4/14/2026 at 1pm and met with Annalyn Artadi, Licensee (LIC) The purpose of the inspection was to deliver complaint findings for the above allegations. On 1/15/26 at 12:30 pm Licensing Program Analyst (LPA), Maie Soliman, arrived unannounced at the agency for the purpose of initiating a complaint investigation related to the above allegation. LPA met with Annalyn Artadi, Administrator. During the course of the investigation, the following documents were gathered and reviewed: LPA requested the following documents for review: Admission agreement, Face Sheet, Needs and Services Plan, Daily Notes, Incident Reports and staff work schedule. No concerns noted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Maie Soliman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: IHEART LIVES INCFACILITY NUMBER: VISIT DATE: 04/14/2026

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


summary: Facility Evaluation

raw_content:
Narrative:
On 4/1/2026 at 1:30pm Licensing Program Analyst (LPA) Maie Soliman arrived unannounced for the purpose of completing the post Licensing inspection. During the inspection LPA met with Annalyn Artadi, Administrator who assisted with the inspection. LPA Soliman conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection is 2:1. LPA observed four bedrooms, three bathrooms and one office. LPA Soliman inspected and/or reviewed the following: I. Operations Complaint Procedures For Youth Reviewed ___X___ Board Minutes Reviewed__NO___ There are only one board member and no board minutes. II. Disaster Preparedness Disaster and mass casualty plan updated and available__01/20/2026______ Quarterly Drills conducted and documented___X____ Disaster preparedness supplies verified ___X_____ III. Emergency Intervention Review of manual restraint log __N/A___ Staff training __No___ IV. Staffing/Volunteers Number of Staff files reviewed ___three___Criminal record clearances verified __three__ First Aid Certificate__three__ Certified Administrators certificate valid and current___two______ Job title/qualification verified ___two___ Hours required training verified__three___ V. Client Records Number of Clients files reviewed ___One___Needs and Services Plan __two__ Centrally Stored Medication and log reviewed _reviewed on 3/3/2026__ JV Reviewed _One_ Psychotropic Medication and log reviewed ___reviewed on 3/3/2026__Cash Resources__reviewed on 3/3/2026__ The following items were reviewed for compliance in the regional office prior to the facility inspection: · Annual fees · Administrator Certificate for: Annalyn Artadi and Raven Esguerra · Emergency Disaster Plan (per H&S Code 1565) · Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC An exit interview was conducted with Annalyn Artadi Administrator and a copy of this report was left with her .


facility_name: INCLUSION SPECIALIZED PROGRAM-HIGHLAND

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
RP stated she arrived at work and observed that C1 had numerous bruises and scratches on them. RP specifically saw a large bruise and scratches to the back, bruises and scratches on the right elbow, and bruising around the right eye. Due to C1 being nonverbal, RP could not question C1 about the injuries. However, C2 informed RP that C2 observed C1 was in the back yard and S1 physically grabbed and drug C1 on the ground over cement stairs. C2 reported that S1 treats C1 "bad" and always tells C1 to go to their room and S1 causes C1's behaviors. RP stated that C1 does at times inflict self-injury but usually does so by biting and the injuries that RP observed did not appear to be self-inflicted. S2 stated they did not know how C1 sustained the large bruise on C1's back. C1's bio-mother stated she had never seen any bruising on C1's face before and is concerned with the bruising. S4 stated that they believed that C2 was telling the truth and witnessed S2 causing the injuries to C1 because C2 was consistent in informing the staff and Administrator of the incident. The Doctor reported that the scrapes and bruising could be caused by C1 being dragged on the concrete. S2 reported they were was present with reporting party when the bruising was discovered on C1's body. S2 stated the protocol for client behavior is "no hands on". The staff are trained to block and redirect the clients. S1 denied ever dragging or going "hands on" with C1. S3 stated they did not see C1 fall on the ground or have any behaviors and does not know how the injury happened. Administrator sent IB investigator an audio recording of the phone call between S4, C2, Administrator where C2 confirms that S1 dragged C1 up to the steps" and kicked C1. Based on IB interviews with Administrator, Audio recording, staff and photos the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. The facility is cited for violation of California Code of Regulations, Title 22, Division Six, Regulation Personal Rights- 84072(D)(11) To be free from physical, sexual, emotional, or other abuse, and corporal punishment. Refer to 9099D for Title 22 deficiencies cited. Exit interview was conducted with agency Social Worker **Confidential names list provided** **Appeal rights given***

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: Momo Duoa, Administrator

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
During LPA's interview with Administrator, she explained to LPA that there were new issues with C1's insurance which inhibited the facility's ability to schedule an appointment with psychiatry to establish care and refill prescriptions for C1. Administrator made made many follow-up calls and attained different records to attempt to get the issues resolved, to no avail. C1's medications ran out on 4/29/2024, and on 5/1/ Administrator obtained a 10-Day emergency supply. The Administrator informed LPA that they did not obtain this sooner as they thought the coverage would go through before that. Afterwards, the issue was resolved and an appointment was scheduled for 5/23/2024. However, with the knowledge that C1's appointment was not until 5/23/2023, on 5/12/2024 after the 10-day emergency supply of medication ran out, C1 was again without medication until 5/15/2024. An emergency supply was obtained on 5/16/2024 and C1 resumed medications as normal. While the Administrator was diligent in following up with the relevant parties in completing all tasks required to attain a doctor's appointment to establish care for C1, and to then attain prescribed medications, there were two lapses in medications being provided to C1 in which emergency medication supplies were not attained timely, resulting in a total of six days of missed medication. Additionally, during LPA's inspection on 6/20/2024, LPA conducted a review of C1's medications. LPA found that for two medications (M1 and M2), there were 20 pills in the bottle, 30 originally prescribed, and eight marked as taken, leaving 2 pills unaccounted for for both. Administrator checked with the Facility Manager and the Medication Administration Records added up correctly, however there was no explanation for four the unaccounted for pills. CCL and the authorized representative did not receive an incident report for both missed medication events (4/29/2024 and 5/12/2024) until 6/12/2024, after the Regional Center Service Coordinator brought to the Administrator's attention that an incident report needed to be submitted. The Administrator informed LPA that with everything going on she failed to create and send the incident reports as required. Based on LPA's observations and conducted interviews, the preponderance of the evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter Sections 80078(a) and 80061(b)(1)(E)&(f), are being cited on the attached LIC 9099D. An exit interview was conducted with FM and a copy of this report, confidential names list, and appeal rights were provided to her.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannouced complaint investigation inspection at the facility and met with Facility Manager Catalina Correa, who assisted with the inspection. LPA investigated this complaint by reviewing client's facility Incident Report related to this complaint, Medication Administration Records (MARs), Individual Placement Plan (IPP), JV220 and JV223 forms, emergency medical consent form and medication administration consent form dated 12/21/2023, medical consent form from the Regional Center dated 4/16/2024, physical medications at the facility, emails, ER discharge paperwork, and Admission Agreement. LPA conducted interviews with the Administrator and the client (C1) on 6/20/2024 and 6/28/2024. During LPA's interview with the client, C1, they informed LPA that they believed they missed medication due to the facility not receiving timely permission from their legal guardian to have it. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: INCLUSION SPECIALIZED PROGRAM-HIGHLANDFACILITY NUMBER: VISIT DATE: 10/18/2024

met_with: Catalina Correa


summary: Facility Evaluation

raw_content:
Narrative:
This documented was Amended, the Case Management was conducted on 5/18/21. Licensing Program Analyst, (LPA) Ignacia Villapudua-Soto arrived at the facility to conduct a case management inspection on 05/18/21 at 3:35. During the inspection, LPA met with Administrator Momo Dua and discussed the incident reports. . Community Care Licensing (CCL) received the following incident reports pertaining to C1. as follows: 3/17/21, incident reports, C1 engaged in noncompliance and tantrum behaviors, staff went to the restroom leaving client outside in the patio, during that time, the client attempted to climb the fence: Incident 4/14/21, C1 become confrontational with roommate and took the facility keys and went to his room. C1 continued his non-compliance and scratched the staff; 04/15/21 incident, C1 began to escalate due to wanted to play games. C1 got the house binders and took them outside. C1 removed documents and ripped them up. The staff tired to redirect him. C1 grabbed the printer and threw it on the floor and broke it. C1 went to the neighbor's fence and grabbed a brick and threw it at the facility van breaking the windshield; 5/10/21 incident: C1 become noncompliant grabbed the daily binders and other objects. Throwing them around the house. Administrator arrived at the facility to provide support to the team. 05/13/21 incident: C1 engaged in noncompliance behaviors and property destruction. C1 swing the refrigerator door open , ripping it off the hinges, destroying containers and the shelves on the door. Administrator stated he is working closely with North Bay Regional Center, Diana Montes for additional support and funding for additional staff for the facility. Administrator stated he also working the Regional office where the facility is going to be remodeling the home for a safer environment. Administrator stated, he is in the process of hiring more staff for the facility. LPA advised Administrator to follow up with LPA with hiring more staff and sharing the plans for the remodeling of the home. LPA is requesting to follow up with the regional center for services for C1. Administrator will follow up with LPA regarding the a plan regarding a safety plan for C1 and Administrator's will follow with the Regional Center regarding additional services for C1. No citations will be given at this time. Exit interview was conducted with Administrator. Administrator will sign and email the signed LIC 809.

met_with: Momo Dua, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Ignacia Villapudua-Soto and Senior Service Coordinator (SC). North Bay Regional Center, Diana Montes arrived at the facility to conduct a joint case management on 05/18/21 at 2: PM. During the inspection, LPA and SC met with Administrator, Momo Dua and discussed the incident. Community Care Licensing (CCL) received an incident report dated May 14, 2021. It was reported that C1 engaged in tantrum behavior, aggression towards staff and self-inflicted injuries due to his behaviors. (Refer to confidential name's list, LIC 811) C1 asked for his IPAD but staff advised C1 that it wasn't time to play with IPAD. C1 proceeded to go to another staff and ask for the IPAD. The staff again confirmed that it wasn't time for his IPAD. C1 become assaultive to staff and fell to the floor and attempted to kick staff. Staff immediately utilized verbal prompts to redirect C1 to the backyard of the facility for activities. C1 continued to actively engage in physical aggression towards staff. Support staff evaded, removing furniture and other items from within the C1's vicinity. Support Staff left the immediate area providing C1 with space and followed the BIP (planned, ignoring/extinction). C1 was in the living room engaging in tantrum behaviors of kicking the floor and biting his hand/arm (laying on his back). Staff continued to provide supervision with no verbal prompts/stimulus toward the consumer. C1 abruptly turned his body 90 degree, and kicked the glass panel of the fireplace and the glass broke and cut C1. Staff utilized first Aid training/protocols to apply pressure to the wound. C1 foot was bleeding profusely. Staff transported C1 to Kaiser Vacaville. Administrator met staff in the hospital lobby to offer support. Administrator assisted nurses and doctors to try to keep C1 calm. C1 become aggressive behaviors with nurses and Administrator. C1 received 3 sutures , and was assessed for 2.5 hours before being released to Administrator. Administrator stated the facility will continue to provide adequate support and redirection to C1 and assure that client is safe and a safety plan in process. Administrator stated he is in communication with the North Bay Regional Center for additional support and for additional staff for this facility. No deficiencies were cited on today's date. Exit interview conducted and a copy of this report was emailed to Administrator, Momo Dua.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Ignacia Villapudua-Soto arrived at the above group home to conduct unannounced ANNUAL/REQUIRED of the facility on 02/16/22 at 3: PM. LPA met with Administrator, Ileya Silva on today's date and explained the purpose of the visit. LPA Villapudua-Soto and the Administrator conducted a joint inspection of the interior and exterior of the group home. The home is a three bedroom, two bath home. The home is licensed for a capacity of 3 ambulatory clients. The clients are developmentally disabled clients. Currently the group home has one client in care. LPA Villapudua-Soto conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The front and back yard were free of clutter; and the passage ways and egress were unobstructed. No potentially hazardous items or areas were observed. Cleaning supplies and extra hygiene items are located in a locked closet at the end of the hallway. Extra bed linens, towels and washcloths are located in the hallway. Medications are stored in a locked cabinet near the kitchen. A fully stocked first aide kit was observed in the medication cabinet. The kitchen was observed to be stocked with ample perishable and non-perishable foods meeting the requirement of two days of perishable and seven days of non-perishable foods. The facility has a posted menu on the fridge. Under the kitchen sink the cabinet is locked with knives and other sharp items. The living room furniture was observed to be in good repair. The living room allowed enough space for clients to engage in indoor activities. The front yard is well maintained. The backyard is concrete. There is a patio table and chairs available to clients. However, the patio table was not in good repair, therefore the Administrator will be disposing of the patio table. LPA observed a locked shed with maintenance supplies in the backyard. Hot water temperatures was tested, however, Administrator will obtain services from a Professional Plumber due to the 1st bathroom shower not regulating hot water. The Administrator will be emailing LPA a copy of the Plumber's receipt that the issue has been addressed. . LPA Villapudua-Soto and Administrator conducted a joint inspection of the facility vehicle/van. The van has the proper car insurance and first Aid and is in good repair. The home has a disaster plan, facility sketch and personal rights posting in the home. The facility has two Carbon Monoxide detector and fire detectors. LPA will return to complete the required Annual/Required inspection at a later date.

met_with: Ileya Silva, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Ignacia Villapudua-Soto arrived at the above Group Home to conduct the continued Required ANNUAL/RANDOM continuation inspection at this facility on 03/8/22 at 12: PM. LPA met with Administrator, Vanessa Baldwin regarding the Continuation of the Annual/Random inspection. LPA Villapudua-Soto and the Administrator conducted a joint inspection of the interior and exterior of the group home. The home is a three bedroom, two bath home. The home is licensed for a capacity of 3 ambulatory clients. The clients are developmentally disabled clients. Currently the group home has one client in care. The facility had the water heater repaired, LPA inspected the water heater and found that hot water in both showers are in good working condition. LPA Villapudua-Soto completed the remaining client/staff records and conducted interviews. LPA will return to deliver the citations at a later date due to technical computer difficulties.

met_with: Vanessa Baldwin, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday, October 1, 2024, at 10:15AM, Licensing Program Analysts (LPA) Brittany Crass and Alyssa Burgess made an unannounced annual inspection at the facility and met with the Administrator, Patricia Ambriz, who assisted with the inspection. LPA's and Administrator conducted a walk-through of the facility. LPA observed an office in the front entry, a dining area, kitchen, living room, three bedrooms, two bathrooms, a laundry room, two storage closets, and a backyard. The facility was in clean, safe, and sanitary condition, aside from the bedrooms which LPA observed sheets with particles and crumbs on them. The administrator stated the youth clean their rooms and make their beds after school, and that they are currently working towards making their beds before leaving for school. In the bedrooms LPA observed sufficient storage space, clean clothing, and desks for school work. Outside, LPA observed a trampoline with a portion of the outer, protective cushion missing, exposing the metal wire springs. The Administrator stated the youth do not use the trampoline anymore and during the visit, submitted a work order to have the trampoline removed by tomorrow. LPA observed chair cushions that had worn covers, exposing the inside cushion. LPA advised the administrator to replace them. In the kitchen, LPA observed at least the minimum requirement of two days of perishable foods. For non-perishable foods, LPA advised the administrator to purchase a few more non-perishable items such as canned soups, beans, rice, etc., as the 7 day requirement seemed low for the amount of youth in care. The hot water in the main bathroom measured at 112 degrees Fahrenheit maximum, which is within the required range of 105 - 120 degrees Fahrenheit. The carbon monoxide detector and smoke detector were operational. There were no buildings and ground deficiencies. (Continued on LIC 809-C). LPA observed that the Foster Youth personal rights, food menu, and complaint procedures were not posted at the facility, however the administrator printed and posted them during the visit. LPA reviewed that monthly board meetings are held every month however upon reviewing the minutes, LPA did not observe the topics needing to be discussed as stated in HSC 5021.1(f) being met. On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Chapter 5, Section 84063(a)(9) on the attached D-Page. LPA also issued multiple Advisory Notes, which are not citations. LPA will return on another date to complete this inspection. An exit interview was conducted with the administrator, and a copy of this report and appeal rights were provided to them.

met_with: Patricia Ambriz


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On Wednesday, October 2, 2024, at 9:35AM, Licensing Program Analysts (LPA) Brittany Crass and Alyssa Burgess, made a subsequent unannounced annual inspection to the facility. LPA's met with Administrator, Patricia Ambriz, who assisted with the inspection. LPA's reviewed three children's files. LPAs found: two youths were missing their signature on their Admission Agreement, one Youth had the medication consent however it was not for Psychotropic Medication. One youth's Psychotropic Medications were not recorded on separate Psychotropic Medication Administration Records (PMAR) as required, and one child had the time missing on their PMAR. For the Needs and Services plans, 3/3 youth files did not list dietary needs, ability to manage their own money, visitation, and planned length of placement. Upon record review, LPA's observed that there was one adult who had a pending fingerprint clearance and was not cleared to work in the facility. The admin stated that effective immediately, this adult will not be at the facility until cleared. LPA's conducted two client interviews, and two staff interviews. Based on interviews, the Facility seemed knowledgeable on their roles, and no personal rights violations were indicated. LPA's recommend re-training on Mandated Reporter Training for all staff. On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Chapter 1 and Chapter 5, Sections 84068(b) and 80019(e) on the attached D-Page. An immediate Civil Penalty in the amount of $500 is being assessed for Background Clearance violation. LPA also issued multiple Advisory Notes, which are not citations. (Report continued on LIC 809-C). LPA will return on another date to complete this inspection. An exit interview was conducted with Administrator and a copy of this report, confidential names list, and appeal rights were provided to her.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility
84068.2(b): Needs and Services Plan

(b) The needs and services plan shall identify the child's needs in the following areas


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC

raw_content:
Narrative:
Facility cited on the attached LIC 9099-D for violation of California Code of Regulations, Title 22, Division 6, regulation 80078(a) Responsibility for Providing Care and Supervision. Facility staff locked minor out of the facility and staff left minor unattended for an extended period of time. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On March 16, 2022 at 3:53pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC and spoke with Carla Flowers, House Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of two (2) clients, one of which is low-functioning non-verbal, eight (8) staff and one (1) witness was interviewed. Confidential interviews, documentary evidence, and LPA review of video footage of the incident revealed adequate supervision was not provided by staff, thus, Client #2 (C2) AWOL'd and Client #1 (C1) was left home alone and unsupervised for an extended period of time. Based on the interviews conducted, documentary evidence, and LPA video review, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 03/16/2022

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

met_with: Carla Flowers-House Manager


raw_content:
Narrative:
Additional statements made by W1 revealed that they do not believe the allegation is true and they do not have any concerns about S1 and C1's placement at the group home. Documentary evidence revealed Special Incident Report was submitted to Community Care Licensing (CCL) on 1/11/2023. LPA obtained a copy of the Special Incident Report and email documentation which reflects the date SIR submitted to CCL. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. 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.

Investigation Findings:
13On March 7, 2023 at 3:21pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC met and spoke with Nnanyere Anyanwu, DSP. The purpose of this visit was to deliver the findings for the above complaint allegation. LPA was informed Ralph Munoz. Administrator was not at the facility. LPA spoke with Administrator by telephone and delivered the findings. During the investigation, a total of three (3) clients, four (4) staff and one (1) witness were interviewed. LPA conducted confidential interviews with clients and staff. Confidential interviews with Client #1 (C1) who is low-functioning non-verbal autistic did not reveal Staff #1 (S1) hit C1 with an object. Additional statements made by staff and Client #2 (C2) did not reveal that S1 hit C1 with a towel. Statements made by Witness #1 revealed that due to C1's autism, C1 will sometimes make up stories that are untrue. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 03/07/2023

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

met_with: Nnanyere Anyanwu-DSP


raw_content:
Narrative:
Although, C1 engaged in self-injurious behavior which resulted in injury to C1, consistent statements revealed staff administered first aid for C1's injury. Consistent statements and documentary evidence also reveal paramedics were called to the facility to assess C1's injury. Although, paramedics assessed C1 and determined that C1 did not require transportation to a hospital emergency room at the time, it was suggested that C1 follow up with urgent care the following day. Confidential interviews revealed staff transported C1 to urgent care on 5/1/2023, the day after the incident. LPA obtained C1's urgent care discharge documentation, Westside Regional Center incident report, and a copy of the staff communication log. LPA was unable to corroborate the allegation, Staff are smoking marijuana on the premises. Confidential interviews and consistent statements did not reveal staff smoking marijuana on the premises of the facility. LPA obtained staffing weekly schedule. Based on the interviews conducted, documentary evidence and information gathered, LPA was unable to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. 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.

Investigation Findings:
13On June 6, 2023, at 8:51am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC and spoke with Melissa Perez, House Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. LPA spoke with Ralph Munoz, Administrator by telephone and was informed Administrator is at another facility location. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. Based on interviews, documentary evidence, and statements obtained during the investigation process, LPA was unable to corroborate the allegation, Staff did not prevent minor from injuring himself. Confidential interviews revealed on 4/30/2023, staff attempted to calm Client #1 (C1) down by verbally re-directing C1 after C1 engaged in self-injurious behavior due to C1 being upset. Consistent statements revealed C1 began to hit their head against the wall. Documentary evidence revealed Client #1 (C1) engages in self-injurious behaviors. LPA obtained a copy of C1's Individual Program Plan (IPP). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 06/06/2023

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

met_with: Melissa Perez - House Manager


raw_content:
Narrative:
Due to a lack of evidence obtained during the investigation, LPA determined that the allegation is Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Facility Administrator

Investigation Findings:
13On January 12, 2023, at 11: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to INCLUSION SPECIALIZED PROGRAMS LLC to conclude the investigation.Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and gathered pertinent information in reference to the allegation. Confidential statements did not corroborate the allegation. The Licensee denied the allegation. Statements were consistent that Child #1 (C1) has been observed to be active, rolling on the floor, and falling to the ground. Statements indicate that facility staff conduct body checks every shift for all children in care. During investigation C1 was observed to have faint bruising to right arm/bicep area. Medical documentation received from the County of Los Angeles Medical HUB for a Forensic Evaluation dated 01/27/2023 indicates that there was no evidence of physical abuse and C1 is in a suitable placement. Statements indicated that staff observed bruising on C1 while bathing and immedialey reported to the facility administrator UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 01/12/2024

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

met_with: Facility Administrator