summary: Facility Evaluation

raw_content:
Narrative:
On 07/20/22 & @ 8: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit for the purpose of annual inspection the following was observed: This is a single-story home located in a residential neighborhood. There are three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, laundry room, a den/TV room, and a converted detached garage (therapy room). Living room: LPA observed a vent for a floor heater and two (2) sofas with throw pillows, lamps, wall paintings. Dining room: table with 6 chairs, wall mounted TV.. Kitchen: Equipped with a double door refrigerator/freezer, plenty of cabinet space, one (1) of which has a lock on it and used to store first aide kit and non-refrigerate medications. There is one (1) stove and LPA observed all five (5) burners ignited with turn of the knobs . Laundry room: washer and dryer, stand up freezer is located off the kitchen and is also accessible from the hallway. LPA observed disinfectants and ant spray above washer in locked cabinet. LPA observed sharps above the washer in another locked cabinets. Den/Tv room: large sectional sofa, flat screen tv, & table, LPA observed the room to have gated patio doors leading to the back yard. Backyard: has outdoor sectional sofa with additional two cushioned seats. Detached garage (Therapy room): four (4) tables and four (4) office) chairs, four (4) metal folding chairs, small fridge, copy machine, and stacked wall storage rack. cont on 809c Bedroom #1: Has two (2) twin size beds with bed linens, new mattresses, two (2) dressers with four (4) drawers, a standard closet with adequate space, an exit window, sufficient lighting, and a smoke detector. Bedroom #2: Has two (2) twin size beds, new mattresses with bed linens, two (2) dressers with four (4) drawers a walk in closet with adequate space, an exit window, sufficient lighting, and a smoke detector. Bedroom #3: Has two (2) twin size beds, new mattresses with linens, two (2) dressers with four (4) drawers, a walk-in closet with adequate space, an exit window, and sufficient lighting. Bathroom #1: Is located at the front of the hallway. It has a bathtub, stand-alone shower, sink, a non-operational electric heater, and functioning toilet. Water temperature meets regulations requirements. Bathroom #2: Is located along the hallway between bedroom #1 and bedroom #3. It has a tub/shower combination, a sink, and a functioning toilet. Both bathrooms were observed to be in working order. Hallways: Has two (2) locked closets, and one with extra linen and hygiene supplies LPA observed two (2) fully charged fire extinguishers. LPA observed the home to have two (2) fire extinguishers, six (6) smoke detectors, and one (1) smoke/carbon monoxide combination detector. The smoke detectors and carbon monoxide alarm were tested and found to be operating properly at the time of visit. No security bars on the bedroom windows. Passageways and porch were clean and in good repair. The front and back yard were free of debris and hazardous material. There were no bodies of water on the premises. No firearms or dangerous weapons in the home. LPA interviewed three (3) staff and two (2) clients during inspection. An exit Interview was conducted, and a copy of this report will be emailed to Administrator. LPA Advised Ms Manns will continue inspection on follow up visit next week.

met_with: Deborah Manns/ Administrator


state: CA

facility_name: PROJECT DESTINY HOME OF HOPE #2

summary: Facility Evaluation

raw_content:
Narrative:
On 08/18/2022 @ 1:50PM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to PROJECT DESTINY HOME OF HOPE #2 for the purpose of conducting a Case Management due to facility accepted a client who is non ambulatory. LPA Phillips interviewed Staff #1. All others will be interviewed at a later date. LPA Phillips requested copy of initial placement contract, any documents that did not list child as non ambulatory. NSP and CFT notes were provided to LPA. LPA will have to return to the facility at a later date to review files and interview staff. There were no deficiencies cited at the time of the visit. Nothing further to report at this time

report_type: Facility Evaluation

visit_type: Case Management

met_with: Darryl Sewell/ Administrator/Mental Health Liason


summary: Facility Evaluation

raw_content:
Narrative:
On 04/05/2023 @ 12: PM Licensing Program Analyst (LPA) Zena Phillips arrived at the above facility for the purpose of conducting a Case Management Investigation follow up.. LPA met with Darryl Sewell who granted access to the facility and provided the census. On March 10, 2023, an Incident Report #846615. was received that Child #1 contacted overnight Staff asking for ride back to the facility. LPA conducted interviews and discussed transportation policy. LPA still needs to interview additional staff to conclude this Case Management investigation. No deficiencies were cited at the time of the visit. A copy of the report will be emailed to Deborah Manns. .

met_with: Darryl/Sewell/ Mental Health Liason


summary: Facility Evaluation

raw_content:
Narrative:
On April 28, 2023 @ 1:55PM Licensing Program Analyst (LPA) Zena Phillips made follow up case management visit for the purpose of interviewing Child #1. LPA Phillips was advised Child #1 was not available due to not at facility. During the investigation LPA Phillips conducted 1 confidential interview. LPA will have to return to the facility at a later date to interview all staff involved. There were no deficiencies cited at the time of the visit. Nothing further to report at this time. .

met_with: Darryl Sewell/ Mental Health Liason


summary: Facility Evaluation

raw_content:
Narrative:
On 06/12/23 & @ 8: AM Licensing Program Analysts (LPAs) Zena Phillips and Lanice White made an unannounced visit for the purpose of required annual inspection. LPAs requested LIC 500, client roster, staff files and client files. Living room: LPAs observed a vent for a floor heater and two (2) sofas with throw pillows, lamps, wall paintings on wall. Dining room: table with 6 chairs, wall mounted TV. Kitchen: Equipped with a double door refrigerator/freezer, plenty of cabinet space, one (1) of which has a lock on it and used to store first aide kit and non-refrigerated medications. There is one (1) stove and LPA observed all five (5) burners ignited with turn of the knob. Laundry room: washer and dryer, stand up freezer is located off the kitchen and is also accessible from the hallway. LPAs observed disinfectants and ant spray above washer in locked cabinet. LPAs observed sharps above the washer in another locked cabinets. Den/Tv room: large sectional sofa, flat screen wall mounted tv, & table, LPAs observed the room to have gated patio doors leading to the back yard. Backyard: has outdoor sectional sofa with additional two cushioned seats. Detached garage (Therapy room): four (4) tables and four (4) office) chairs, four (4) metal folding chairs, small fridge, copy machine, and stacked wall storage rack. LPAs interviewed two (2) staff and two (2) residents during the inspection. LPAs reviewed the following during the inspection: Sexual Harassment information regarding the Emergency Preparedness. LPAs reviewed 5 client records Needs & Services, medical logs and personal rights signature page. LPAs reviewed criminal records and confirmed that all staff were also cleared. LPAs reviewed 5 staff files for required training's. Direct Care staff records and facility manager. All files and documents are in order. LPA reviewed the facility binder that included specific training's. Training's include the following: Policies & Procedures; Health & Safety: Emergency Procedures: Medication; Trauma-Informed Care; Job Duties; and information about the Stakeholders. LPAs observed a wall mounted fire extinguisher in the hallway, and one carbon monoxide detector. LPAs observed the contents of the first aid- kit which included, a thermometer, first-aid guide, scissors, tweezers, and gauze. LPAs observed facility van a Chrysler six (6) passenger van, with valid insurance. This inspection has been concluded. There were no deficiencies cited at this time. Exit Interview was conducted and a copy of this report was left with Darryl Sewell/ Mental Health Liaison.

visit_type: Annual

met_with: Kynelle Spencer/Facility Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 07/18/2024 & @ 8: AM Licensing Program Analysts (LPA) Zena Phillips and Licensing Program Analyst (LPA) Kim Dear made an unannounced visit for the purpose of required annual inspection. LPAs requested LIC 500, client roster. LPA's met with Kynelle Spencer/ Facility Supervisor who granted access to the facility. Ms Spencer called Licensee and LPA's were advised Amanda Tovar/Executive Assistant would arrive shortly to open office for LPA's. The facility is licensed to care for 6 children ages 12 to 17 and non-minor dependents, ambulatory only. At the time of today's inspection, the census was 4. This is a one story resident located in a residential area. Living room: LPAs observed a vent for a floor heater and two (2) sofas with throw pillows, lamps, wall paintings on wall. Dining room: table with 6 chairs, wall mounted TV. Kitchen: Equipped with a double door refrigerator/freezer, plenty of cabinet space, one (1) of which has a lock on it and used to store first aide kit and non-refrigerated medications. There is one (1) stove and LPAs observed all five (5) burners ignited with turn of the knob. LPAs observed adequate food supply, in refrigerators, freezer and pantry. Laundry room: washer and dryer, stand up freezer is located off the kitchen and is also accessible from the hallway. LPAs observed disinfectants and ant spray above washer in locked cabinet. LPAs observed sharps above the washer in another locked cabinets. Den/Tv room: large sectional sofa, flat screen wall mounted tv, & table with four (4) chairs , LPAs observed the room to have gated patio doors leading to the back yard. Backyard: has outdoor sectional sofa with additional two cushioned seats. Detached garage (Therapy room): four (5) tables and four (3) office) chairs, four (5) metal folding chairs, small fridge, copy machine, wall mounted TV, and portable air conditioning unit. Small table with additional snacks. cont on 809c LPAs reviewed the following during the inspection: Sexual Harassment information regarding the Emergency Preparedness. LPAs reviewed 3 client records Needs & Services, medical logs and personal rights signature page. LPAs reviewed criminal records and confirmed that all staff were also cleared. LPAs reviewed 3 staff files for required training's. LPA observed the following completed training's: Helping Children Cope in Crisis, an Trauma Informed Care Learning Path. Direct Care staff records and facility manager. All files and documents are in order. LPA reviewed the facility binder that included specific training's. Training's include the following: Policies & Procedures; Health & Safety: Emergency Procedures: Medication; Trauma-Informed Care; Job Duties; and information about the Stakeholders. LPAs observed a two (2) wall mounted fire extinguishers in the hallway, and one carbon monoxide detector. LPAs observed the contents of the first aid- kit which included, a thermometer, first-aid guide, scissors, tweezers, and gauze. LPAs observed facility van a Chrysler six (6) passenger van, with valid insurance and registration. LPAs observed, first aid kit, seat belts, lights all functional. This inspection has been concluded. LPAs observed the facility to be clean , safe and sanitary. There were no deficiencies cited at this time. Exit Interview was conducted and a copy of this report was left with Deborah Manns/ Licensee.

met_with: Amanda Tovar/Executive Assistant


summary: Facility Evaluation

raw_content:
Narrative:
On April 29, 2025, at 10: AM, Licensing Program Analyst Justine Armstrong (LPA) and Enrique Hernandez Licensing Program Manager (LPM) arrived at the above facility for the purpose of conducting an unannounced Case Management other - To investigate concerns regarding compliance with the STRTP investigation. LPA met with Program Administrator and a health and safety assessment was conducted prior to entering facility. The Community Care Licensing Department has received concerns regarding the facility's failure to provide mental health services to clients in care, staff members driving clients in personal vehicles, and changes in the staffing department with the Head of Service. During the investigation, the LPA interviewed the Administrator, Staff 1 and Staff 2. The Licensing Program Analyst (LPA) has requested the following documents: CFT notes, Needs and Service plan, vehicle insurance, vehicle registration, the policy on vehicle safety and transportation for the specified vehicle LIC 500, and the client roster. The LPA also informed the Administrator about the importance of promptly submitting Unusual Incident Reports in compliance with regulations and addressing the staffing changes. At this time, there is insufficient information to support that the above allegations occurred. This Case Managment needs further investigation. An exit interview was conducted, and a copy of this report was provided to facility staff.

met_with: Deborah Manns


facility_name: PROJECT SIX

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Additionally, LPA was informed during confidential interviews that that Child 1 becomes aggressive towards staff unprovoked. Due to statements from all relevant parties and facility records review, the above allegation is concluded as Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Supporting evidence include the following: Staff interviews and NSP. Exit interview conducted, and a copy of this report was emailed to Jerry Majewsky/ STRTP Program Director.

Investigation Findings:
13On 12/16/2021 @ 1: PM Licensing Program Analyst (LPA) Zena Phillips conducted a subsequent investigation visit and spoke with Jerry Majewsky , STRTP Program Director for the purpose of delivering findings and discussing investigative outcome concerning the above-mentioned allegation. Initial investigation was conducted on 07/25/2021. During the course of this investigation LPA Phillips conducted confidential interviews with relevant parties. Staff stated they would never hit a child in care. All Staff denied the above said allegation. Multiple Staff interviews did not reveal any unfair treatment toward C1. Staff admitted after Child 1 graduated and started vocational school behavior changed to aggression toward staff and others. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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: PROJECT SIXFACILITY NUMBER: VISIT DATE: 12/16/2021

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

report_type: Complaint Investigation

met_with: Jerry Majewsky/ STRTP Program Director

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On November, 19, 2021 at 8am Licensing Program Analyst (LPA) Bernice Karnsrithong Project Six Group Home for the purpose of conducting an Annual Inspection. LPA Karnsrithong met with Administrator, Elin Bradley. The current census of the facility is sixteen (16). This is a two-story facility that provides care and supervision to children ages 11 to 17 years of age and ambulatory only. There are no pool or bodies of water in the premises of the facility. The facility is located in a gated commercial area. During the inspection LPA Karnsrithong observed an outside common area with sectional patio seating and tables. The outside common area is fenced in and located in front of the facility main door. This area is used by clients and staff as needed. There is also a conference room located in the school facility. This room has a large desk, eight (8) chairs, shelves and drawers to be used for storage. This room is mainly used for staff or private meetings. This is a two-story facility and the group home is located upstairs. The facility is fenced in and there is a school adjacent to the facility. There is also an office reception area located next to the conference room. LPA Karnsrithong reviewed staff training records (Emergency Intervention, Trauma Informed Care, First Aid and CPR). LPA Karnsrithong will come back on a later date to complete the inspection. A copy of this report will be emailed to the facility on a later date.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/10/2021, LPA Karnsrithong arrived at the facility at 9:30am to conduct an inspection regarding capacity decrease application. LPA met with administrator, Elin Bradley who provided the tour of the facility. The facility is located inside a gated compound that has four (4) separate buildings. The main gate is gated and secured. The first building is the school lobby, administrative offices and a gym that is used by the facility. The gym is currently not being used due to a erupted hydrant accident that occurred this week. No clients have accessed to the gym at this time while it undergoes repairs. The second building is the high school and middle school campus. The third building is the elementary campus and the outpatient clinic and wraparound and Family Preservation Services. The fourth building has the school, the facility office, and the client's residential unit. The facility has a private gate that lets you inside the two-story building. The facility is located upstairs on the 2nd floor. The 1st floor is used as an outpatient services office and clients have no accessed to the 1st floor. CARF accreditation has been issued on July 3, 2019 and is valid until 2022. Current capacity for licensing is at twenty-four (24) and licensee is requesting for capacity to be decreased to sixteen (16). Administrator Certification is valid until December 7, 2022. The facility currently has sixteen (16) clients under their care. There are sixteen (16) bedrooms. Each bedroom is equipped with one (1) twin-sized bed, closet space, adequate lightning and two (2) dressers. Each bedroom has the emergency disaster plan and facility sketch plan posted. Each bedroom has its own smoke alarm. Each bedroom also has one (1) window with blinds. Clients have accessed to five (5) bathrooms that have showers, sinks, toilet that are in good working condition. Only one (1) client at a time is permitted to use the bathrooms. Staff uses separate bathrooms that is kept locked and inaccessible to clients. There are four (4) common area spaces inside the facility that is utilized by clients for studying, tutorials, games, video games, music and arts. There are seven (7) office spaces that are being used by both mental health, direct care, and administrative staff. One (1) office space is currently being renovated during the time of the inspection. There is one (1) common space area located outside across the facility door entrance. (Page 1 of 2) The kitchen area is spacious and is equipped with stoves, refrigerators, dishwasher, and sinks. Sharp items are stored away and locked in a drawer and is inaccessible to clients. All kitchen items and utensils are well organized and labeled. A kitchen island is located in the center and is used for preparing food. Small kitchen appliances (coffee maker, two (2) microwaves, air fryer, pressure cooker) is also available to use. There is a separate pantry across the kitchen which stores extra perishable and non-perishable food items. This room is kept locked at all times. Kitchen is clean and well maintained. The dining area is located next to the kitchen and meals are served buffet style. Menu is posted in the dining area. There are two (2) laundry rooms that is being used by clients and has sufficient laundry supplies. The facility has a medication room that is maintained by the facility nurse. This room is used to store medication, COVID-19 tests, Personal Protective Equipment (PPE), medication logs, vitamin supplements, and other medical supplies. All client medications are labeled and documented when provided to clients. Utility shut off valves are located outside the facility and is locked. Facility vehicles are in good working conditioned and parked in the facility parking area. Facility maintenance logs are kept in the vehicles for review. There are two (2) locked closet rooms that are used to store disinfectant and cleaning supplies for the facility. During this visit, LPA Karnsrithong has interviewed two (2) clients and three (3) staff. LPA also reviewed staff and client records which are stored appropriately. Staff records are kept offsite but can be accessed during inspection. The facility provides in-house mental-health services to all clients and updates their needs and services plan quarterly. Child Family Meetings are conducted regularly and documented in the client's files as well. Facility logs are all stored in the administrative office. Staff are provided emergency intervention and trauma informed training as needed and are documented in the personnel files. All licensing postings, facility policies, and children's rights are posted in the hallway. There are eight (8) fire extinguishers and two (2) air purifiers throughout the facility. There are no deficiencies cited at this time. A copy of this report will be provided to the facility. (Page 2 of 2)


summary: Facility Evaluation

raw_content:
Narrative:
On December 10, LPA Bernice Karnsrithong has arrived at 9:30am to conduct a continuation of an annual inspection. LPA Karnsrithong met with Administrator, Elin Bradley who provided access and tour to the facility. The facility is located inside a gated compound that has four (4) separate buildings. The main gate is gated and secured. The first building is the school lobby, administrative offices and a gym that is used by the facility. The gym is currently not being used due to a erupted hydrant accident that occurred this week. No clients have accessed to the gym at this time while it undergoes repairs. The second building is the high school and middle school campus. The third building is the elementary campus and the outpatient clinic and wraparound and Family Preservation Services. The fourth building has the school, the facility office, and the client's residential unit. The facility has a private gate that lets you inside the two-story building.The facility is located upstairs on the 2nd floor. The 1st floor is used as an outpatient services office and clients have no accessed to the 1st floor. CARF accreditation has been issued on July 3, 2019. COVID-19 checks are conducted upon arriving the facility. The staff takes your temperature and conducts symptom checks for safety. There are two (2) air purifiers on each side of the hallway for COVID-19 prevention as well. The facility currently has 16 bedrooms that clients are currently staying in. There is one (1) counselor for four (4) clients, one (1) mental health therapist, one (1) activity coordinator and one (1) facility manager for each shift. There is adequate staffing coverage for the clients in the facility. There are two (2) non minor dependents and fourteen (14) minors currently placed in the facility. LPA Karnsrithong has interviewed two (2) clients and reviewed three (3) client's files. There are currently ten (10) staff working at the time of the inspection. LPA Karnsrithong has interviewed three (3) staff and three (3) staff files. There is a private room used for phone calls. There are eight (8) operating fire extinguishers located throughout the facility. (Page 1 of 3) There are two (2) carbon monoxide alarms on each side of the facility hallway. All stairway exits have egress alarms for safety. There are currently three (3) operating facility vehicles in the driveway. Other facility vehicle is being used, while the other one is undergoing repairs. LPA Karnsrithong has observed the following during the visit: Bedrooms: There are sixteen (16) bedrooms equipped with one (1) twin sized bed, closet space, adequate lightning and two (2) dressers. Each bedroom has the emergency disaster plan and facility sketch plan posted. Each bedroom has its own smoke alarm. Each bedroom also has one (1) window with blinds. Bathrooms: There are five (5) bathrooms that are used by clients. There are two (2) gender neutral bathrooms. All bathrooms have showers, sinks, toilet that are in good working condition. There are two (2) staff bathrooms that has a toilet and sink. The staff bathroom is locked and inaccessible to clients. Storage: There are two (2) hallway closets being used to store disinfectant and cleaning supplies. These rooms are kept locked at all times. Cleaning equipment such as vacuums and mops are stored here as well. Common Rooms: There are four (4) common areas that are utilized by clients upstairs. There is milieu area that is located in the lobby that is used for studying, tutoring and therapy. It has wooden chairs and tables. The study lounge is located adjacent to the milieu and has couches, television, video games, books, board games, and five (5) computers. This room is locked when not in used and computer usage is being monitored and supervised by staff. There is an art room that has chairs, tables, art supplies, television, and video games for clients to used. The activity coordinator's office is also located next to the art room. There is a music room that is equipped with musical instruments, couches, and digital music equipment that clients can used. There is another lounge located in the girl's hallway that is equipped with a couch, television, and two (2) computers. Laundry Room: There are two (2) laundry rooms located in the facility on each side of the hallway. The laundry room stores linens and laundry supplies. The laundry room located in the boy's hallway stores the toiletries for the clients. Each client has their own labeled cubby/container to be used for toiletries. (Page 2 of 3) Kitchen Area: The facility has a spacious kitchen that has two (2) stoves, two (2) refrigerators, one (1) dishwasher and a sink. Sharp items are stored away and locked in a drawer. All kitchen items and utensils are well organized and labeled. A kitchen island is located in the center and is used for preparing food. Small kitchen appliances (coffee maker, two (2) microwaves, air fryer, pressure cooker) are also available to use. Face masks and gloves are also accessible in the kitchen for safety purposes. There is a cook/chef that prepares and cooks the meals for the clients. There is a locked pantry on the other side of the kitchen that stores snack items, dry goods, grains, and one (1) refrigerator to be used to store extra food. There are enough perishable and non-perishable food supplies for the clients. The pantry also stores the client's individual food items that they may have purchased or provided to them by family or their social worker. It is stored in a plastic shelf that is labeled. Dining Area: The dining area has five (5) tables and serve meals buffet style. The menu is posted in the dining area. There are three (3) trash cans. There is a water dispenser also located in this area. Medication Room: This room is used to store medication, COVID-19 tests, Personal Protective Equipment (PPE), medication logs, vitamin supplements, first aid kits and other medical supplies. This room is maintained by the facility nurse. If the nurse is unavailable the facility manager provides the clients with medications as needed. All medications are stored accordingly, labeled, and includes the prescribing pharmacy, the type of medication, and the physician who prescribed the medication. Offices: There are four (4) offices located close to the boys' hallway. These offices are mainly used for mental health staff and some therapeutic services are also conducted in these offices. There is one (1) staff office in the middle of the hallway for direct care staff. Currently another office is being remodeled for the facility manager to use. There is one (1) administrative office that stores client's files, facility logs and other pertinent facility documentation. Medication Room office is also located in the hallway and stores medication, first aid kits and medication logs. There is one (1) office in the facility used by the program director. There is also one (1) office for the activity coordinator. There is a total of seven (7) office rooms in the facility. There were no deficiencies cited at this time. A copy of this report will be provided to the facility on a later date. (Page 3 of 3)


facility_name: PROMESA BEHAVIORAL HEALTH VAN NESS

summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 12/08/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to inform the facility of the outcome of the above complaint inspection.Met at the facility by House Manager Mayra Lares. Based on confidential interviews conducted and a physical plant inspection conducted by this LPA, the telephone was in a public area without doors and the minors were not able to have privacy. Based on the above, the complaint is Substantiated. Deficiency on the attached page. A copy of this report is left with House Manager Mayra Lares. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Tamara Melikian 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: PROMESA BEHAVIORAL HEALTH VAN NESSFACILITY NUMBER: 107206872

met_with: Mayra Lares

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Promesa Behavioral Health-Van Ness and met with Manager Kayla Delgado to conduct confidential interviews and deliver findings of investigation. CS and Investigator Ruben Munoz conducted investigation that included review of documentation and confidential interviews and due to inconsistencies in the information obtained a preponderance of the evidence could not be found that the allegations occurred as reported. Although the allegations may or may not have occurred without a preponderance of the evidence the allegations are deemed Unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report and LIC Appeal Rights left at the facility at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Kayla Delgado


summary: Facility Evaluation

raw_content:
Narrative:
On November 9, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an annual inspection of the facility indicated above. Met at the agency by Residential Program Director Arlene Vargas. Staff files and training records were inspected on this date. A review of staff records on 11/09/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. The annual inspection will be completed at a later date. There are no deficiencies to be cited on this date.

met_with: Arlene Vargas


summary: Facility Evaluation

raw_content:
Narrative:
On November 11, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted a follow up annual inspection at the above facility. Met by Administrator Joanna Solorio. At 1:00PM, an inspection of client files and medication logs was conducted. At 1:45PM, an inspection of the physical plant was conducted. LPA observed adequate food supply, appropriately maintained yard, adequate bedding, storage space, activity space, hot water that measured 112 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 2:15PM, an interview of S1 (see LIC811 dated 11/12/2021) was conducted. At 2:30PM, an interview of S2 (see LIC811 dated 11/12/2021) was conducted. The exit interview was conducted at 3:00PM and a copy of this report given to the Administrator. There are no deficiencies to be cited on this date.

met_with: Joanna Solorio


summary: Facility Evaluation

raw_content:
Narrative:
On 01/31/2022, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 10:30AM. During the inspection, LPA met with Joanna Solorio, Administrator and inspected the facility inside and out. LPA reviewed two children's records and reviewed two staff personnel records for the facility at 10:30AM. A medication count was conducted at 1:00PM. LPA interviewed two staff at 1:30PM. LPA did not interview any children in the home as there is only one dependent in the facility and that child was at school. No deficiencies to be cited at this time. LPA conducted exit interview with Joanna Solorio, Administrator. LPA provided the summary report to Joanna Solorio, Administrator upon completion.


summary: Facility Evaluation

raw_content:
Narrative:
On February 9, 2022, Licensing Program Analyst (LPA) Tamara Melikian conducted a follow up SB Psychotropic Medication inspection at the above facility to interview client # C2 (see LIC811 dated 01/31/2022). Met at the facility by Administrator Joanna Solorio. Interview conducted at 1:35PM. There were no deficiencies cited on this date. A copy of this report was left with Administrator Joanna Solorio upon completion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/11/2022, Licensing Program Analyst (LPA) Tamara Melikian travelled to the above facility to conduct an Annual inspection. Met by Administrator Joanna Solorio. At 9:15AM, an inspection of the physical plant was conducted. LPA observed adequate food supply, adequate bedding, storage space, activity space, hot water that measured 114 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 9:30AM, an inspection of client files was conducted as well as the centrally stored record and medications. At 10:15AM, an interview of S1 and S2 (see LIC811 dated 04/11/2022) was conducted. At 10:40AM, an interview of C2 was conducted. It was requested by this LPA to interview the other youth and they all refused. Staff records are inspected at 11:15AM. The exit interview was conducted at 12:00PM and a copy of this report given to the Administrator. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced annual random inspection at the above facility. LPA met at the facility by Administrator Joanna Solorio. An inspection of the facility was conducted and the following was observed: No clients were residing in the home; therefore, no client nor staff files were inspected on this date. The licensee stated that the facility is closed due to staffing issues at this time. The facility was inspected indoors and outdoors. Hot water temperature measured at 106 degrees. LPA Melikian observed that there was an adequate supply of non-perishable items and no perishable items. LPA observed an adequate supply of furnishings, linens, and storage space for the clients. Cleaning chemicals inaccessible to the clients. There are no pets at the facility. Per the Administrator, there are no weapons at the facility. There are no bodies of water at the facility. There have been no deficiencies in the prior 12 months. There are no deficiencies to be cited on this date. LPA left a copy of this report to Administrator Joanna Solorio.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection at the above corporate offices to review the staff file of Administrator Joanna Solorio. Met at the offices by Residential Program Administrator Arlene Vargas. Staff file #1 (see LIC811 dated 12/20/2022) reviewed on this date. There are no deficiencies to be cited on this date. A copy of this report is left with Residential Program Director Arlene Vargas on this date.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on February 15, 2023 at 2:00PM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2) and is a follow up to the inspection conducted on February 10, 2023. During the inspection, LPA met with Jodee Romero, Human Resource Manager. LPA reviewed 1 staff personnel file. There are no deficiencies to be cited on this date. LPAs provided a copy of the licensing report to Human Resource Manager, Jodee Romero.

met_with: Jodee Romero


summary: Facility Evaluation

raw_content:
Narrative:
On 03/22/2023, Licensing Program Analyst (LPA) Tamara Melikian travelled to the above facility to conduct an Annual inspection. Met by Administrator Joanna Solorio. At 9:15AM, an inspection of the physical plant was conducted. LPA observed adequate food supply, adequate bedding, storage space, activity space, hot water that measured 113 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 9:30AM, an inspection of client files was conducted as well as the centrally stored record and medications. At 10:15AM, an interview of S1 and S6 (see LIC811 dated 03/22/2023) was conducted. At 10:45AM, and interview of C2 was conducted, C1 went back to sleep and was unable to be interviewed. At 11:15AM, staff records were inspected. The exit interview was conducted at 12:00PM and a copy of this report given to the Administrator. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Corina Carrillo conducted a case management inspection May 16, 2023 at 11:00AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 6 out of Direct Care Staff and 2 out of 2 youth files were reviewed. 2 out of Direct Care Staff and 0 out of 2 youth were interviewed. (See the Confidential Names List, LIC 811, May 16, 2023.) The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Carrillo observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Joanna Solorio.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/10/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection to conduct a physical plant inspection at the facility. Met by House Manager Mayra Lares. A physical plant inspection was conducted. The upstairs bathtub had a leak which has now been fixed. There are blinds in a bedroom that were broken by a previous client and will be fixed or replaced. There are no deficiencies to be cited on this date. A copy of this report is left with House Manager, Mayra Lares.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/12/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection for the above facility. Met by Residential Program Director Arlene Vargas. The purpose of the inspection is to discuss incident reports that were not submitted to the Department past the required time frame. Reports will be forwarded within the correct time frames moving forward. There are no deficiencies to be cited on this date. A copy of this report is left with Arlene Vargas, Residential Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on April 17, 2024 at 9:00AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Joanna Solorio, Administrator and inspected the facility inside and out. LPA reviewed 1 child record and 2 staff personnel files on site at the facility. LPA reviewed 1 child psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 1 child currently prescribed psychotropic medication. LPA provided a copy of the licensing report to Joanna Solorio, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Joanna Solorio, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/20/2024, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management for the above facility. Met by Administrator Joanna Solorio. On 05/14/2024, this LPA received initial notification of an incident that occurred on 05/10/2024. The incident and reporting requirements were discussed with Ms. Solorio. There are no deficiencies to be cited on this date. A copy of this report is given to Ms. Solorio, Administrator on this date.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analyst (LPA) Reyna Martinez. LPA met with Arlene Vargas, Administrator. LPA provided the Administrator the entrance checklist and requested the necessary documents. An inspection of the physical plant was conducted. Centrally stored medications are maintained in a locked closet in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors and carbon monoxide were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced January 2025. Individual beds were observed with appropriate clean linens and are in good repair. The facility is CARF Accredited through 01/31/2027, and Mental Health Program Approval through 04/09/2025. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 69 degrees. Hot water temperature measures 110 degrees. Facility has cameras in the common areas. No firearms or weapons are allowed in the facility. LPA reviewed the facility's disaster plan, sampled medication and reviewed facility logs. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 administrator, 1 house manager, 1 clinician, 9 direct care staff, and 1 mental health rehabilitation specialist. An inspection of 4 client files was conducted as well as the centrally stored record and medications. An interview of C1 and C4 (see LIC811 dated 03/24/2025) was conducted. An interview of S2 and S3 (see LIC811 dated 03/24/2024) was conducted. An inspection of 5 staff records were inspected and met all regulatory requirements. A review of the Licensing Information System on March 18, 2025, indicates that all facility staff are associated to the STRTP had DOJ, FBI, and child abuse index check clearances. There are no deficiencies to be cited on this date. The exit interview was conducted a copy of this report given to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Reyna Martinez on April 16, 2025 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Lydia Baeza, Child Care Worker and inspected the facility inside and out. LPA reviewed 0 child records and 2 staff personnel files on site at the facility. LPA reviewed 0 child psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 0 child currently prescribed psychotropic medication. LPA provided a copy of the licensing report to Lydia Baeza, Child Care Worker. No deficiencies are being cited at this time. LPA conducted exit interview with Lydia Baeza, Child Care Worker.

met_with: Lydia Baeza


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on February 10, 2023 at 10:30AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Joanna Solorio, Administrator and inspected the facility inside and out. LPAs reviewed 0 child's records and 2 staff personnel files on site at the facility. LPAs reviewed 0 child's psychotropic medications and medication records as child was placed less than 30 days ago. LPAs interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed no children currently taking psychotropic medication. LPAs provided a copy of the licensing report to Administrator, Joanna Solorio. During the inspection the LPA observed deficiencies (see attached 809D), plan of corrections were discussed and appeal rights were provided. LPAs provided a copy of the licensing report to Joanna Solorio, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/24/2026, Licensing Program Analyst (LPA) Reyna Martinez traveled to the above facility to conduct an Annual inspection. Met by Administrator Brian Zirate. LPA provided Administrator the entrance checklist and requested the necessary documents. An inspection of client files was conducted as well as the centrally stored record and medications. LPA reviewed the facility's disaster plan and reviewed facility logs. Appropriate staff/client ratios were verified during this inspection. All met the regulatory requirements. An inspection of the physical plant was conducted. LPA observed adequate food supply, adequate bedding, storage space, activity space, hot water that measured 105 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. The facility is CARF Accredited through 01/31/2027, and Mental Health Program Approval through 04/09/2026, and are awaiting a response from DHCS. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 69 degrees. The fire extinguisher is properly charged and was last serviced December 2025. 5 staff files were reviewed and meet all regulatory requirements. 2 staff were available to be interviewed. 4 records of client was reviewed. All clients in the home were at school and will be interviewed at a later time. A review of the Licensing Information System on April 15, 2026, indicates that all facility staff listed on the LIC 500 under Promesa Behavioral Health Van Ness House are associated to the STRTP had DOJ, FBI, and child abuse index check clearances. There are no deficiencies to be cited on this date. The exit interview was conducted and a copy of this report is left with Administrator Brian Zirate.

met_with: Brian Zirate


facility_name: PROMESA, BARSTOW HOUSE

raw_content:
Investigation Findings:
13On 10/11/2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint investigation for the above facility. Met by Residential Program Director Arlene Vargas. Interviews conducted and information and documents obtained. Based on information obtained, there are conflicts in statements regarding the above allegations. In addition, clients #1 and #2(see 811 dated 10/11/2022) refused to be interviewed. Based on the above, the complaint is Unsubstantiated. There are no deficiencies to be cited on this date. A copy of this report is given on this date to the Residential Program Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Tamara Melikian LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On 12/06/2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint investigation for the above facility. Met by Administrator Joanna Solorio. Interviews conducted, information obtained and a physical plant inspection conducted. Based on interviews conducted and a physical plant inspection by this LPA, the temperature in the facility is not comfortable. Based on the above, the complaint is Substantiated. Deficiency on the attached page. A copy of this report is given on this date to the Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Tamara Melikian 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 24-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, E SHAW AVE FACILITY NAME: PROMESA, BARSTOW HOUSEFACILITY NUMBER: 107200789


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Odalys Reynoso Diaz, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging provider refused to pick up minor from Juvinile hall. The facility did refuse to pick up the minor, however due to clients physical and verbally assultive aggressive behavior towards their peers and staff, for the safety and well being of the other clients in the home, the facility did not pick up the minor. The facility contacted the authorized representative for transportation of the minor. LPA conducted interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Odalys Reynoso Diaz


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Odalys Reynoso Diaz, House Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging staff engaged in inappropriate interactions with minor in care. LPA conducted interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Odalys Reynoso Diaz, House Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging Staff is allowing marijuana to be smoked on facility premises. LPA conducted interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an annual inspection of the facility indicated above. Met at the agency by Residential Program Director Arlene Vargas and Administrator Joanna Solorio. Staff files and training records were inspected on this date. In addition, client files and medication logs were inspected on this date. A review of staff records on 09/23/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. The annual inspection will be completed at a later date. There are no deficiencies to be cited on this date.

met_with: Joanna Solorio, Arlene Vargas


summary: Facility Evaluation

raw_content:
Narrative:
On October 6, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted a follow up annual inspection at the above facility. Met by Administrator Joanna Solorio. At 1:30PM, an inspection of the physical plant was conducted. LPA observed adequate food supply, appropriately maintained yard, adequate bedding, storage space, activity space, hot water that measured 110 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 2:00PM, an interview of C3 (see LIC811 dated 10/06/2021) was conducted. At 2:20PM, an interview of C1 (see LIC811 dated 10/06/2021) was conducted. At 2:45PM, an interview of S1 (see LIC811 dated 10/06/2021) was conducted. At 3:10PM, an interview of S3 (see LIC811 dated 10/06/2021) was conducted. The exit interview was conducted at 3:30PM and a copy of this report given to the Administrator. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On November 9, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an SB Psychotropic Medication Inspection of the facility indicated above. Met at the agency by Residential Program Director Arlene Vargas. Staff files and training records were inspected on this date. A review of staff records on 11/09/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. The inspection will be completed at a later date. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted a follow up case management-medications to interview youth. Met at the facility by Angelica Gamboa. At 3:30PM, one client was interviewed. The other client refused to be interviewed. There are no deficiencies to be cited on this date. A copy of this report is left with staff member Angelica Gamboa.

met_with: Angelica Gamboa


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced Plan of Correction inspection at the facility indicated above. Met at the facility by Angelica Gamboa. At 3:10PM, an inspection of the facility was conducted. The facility was clean, safe and sanitary. In addition, the yard was free from debris. There are no deficiencies to be cited on this date. A copy of this report is left with staff Angelica Gamboa.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/05/2022, Licensing Program Analyst (LPA) Tamara Melikian travelled to the above facility to conduct an Annual inspection. Met by Administrator Joanna Solorio. At 9:15AM, an inspection of the physical plant was conducted. LPA observed adequate food supply, adequate bedding, storage space, activity space, hot water that measured 111 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 9:30AM, an inspection of client files was conducted as well as the centrally stored record and medications. At 10:15AM, an interview of S1 and S2 (see LIC811 dated 04/05/2022) was conducted. At 10:40AM, an attempted interview of C4 was conducted, however the youth began to not feel well so was not interviewed. Staff records are at the corporate office and will be inspected at a later date. The exit interview was conducted at 11:00AM and a copy of this report given to the Administrator. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/02/2022, Licensing Program Analyst (LPA) Tamara Melikian travelled to the above facility's corporate office to complete an Annual inspection. Met by Human Resource Manager Jodee Romero. At 10:00AM, staff files were inspected as well as training records. There are no deficiencies to be cited on this date. A copy of this report was left with Jodee Romero, Human Resource Manager.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Britanee Windom and LPA Carrillo conducted a case management inspection on 07/19/22 at 10: AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 6 out of Direct Care Staff and 3 out of 3 youth files were reviewed. 2 out of Direct Care Staff and 3 out of 3 youth were interviewed.(See the Confidential Names List, LIC 811, July 19, 2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, monthly assessments, and crisis intervention plans, the licensee uses trauma informed and evidence based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Windom and LPA Carrillo observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. . Continued... LPA Windom and LPA LPA Carrillo mentioned to Administrator Solorio and Director of Residential Programs Arlene Vargas that the Board of Director Meeting Minutes provided to LPA Windom had general information regarding the review of SIRs. LPA Windom explained that The Board of Director Meeting Minutes should accurately document the review of specific SIRs involving law enforcement in the quarterly meetings. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Joanna Solorio

met_with: Director of Residential Programs Arlene Vargas and Administrator J. Solorio


summary: Facility Evaluation

raw_content:
Narrative:
On 08/29/2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection to discuss an incident that occurred on 08/16/2022 with client #1 (see LIC811 dated 08/29/2022). Client #1 has court ordered restitution as per documents inspected by this LPA on this date. Amounts from further incidents will not be deducted from client #1's allowance without updated court orders per the Administrator. There are no deficiencies to be cited on this date. A copy of this report is left with Administrator Joanna Solorio.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/29/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection. Met by Residential Program Director Arlene Vargas. The purpose of the inspection is to discuss the current Emergency Intervention Plan and the current Interim Licensing Standards. A current copy of the EIP will be forwarded to this LPA on or before 07/07/2023. There are no deficiencies to be cited on this date. A copy of this report is left with Residential Program Director Arlene Vargas.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on July 5, 2023 at 12:00PM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Joanna Solorio, Administrator and inspected the facility inside and out. LPA reviewed 2 child's records and 2 staff personnel files on site at the facility. LPA reviewed 2 child's psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed two children on site currently on psychotropic medication. LPA provided a copy of the licensing report to Administrator, Joanna Solorio. No deficiencies are being cited at this time. LPA conducted exit interview with Antolin Garza, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/10/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection at the above facility. Met at the facility by facility manager Angelica Gamboa . The purpose of the inspection is to interview client #1 (see LIC811 dated 07/10/2023) regarding an incident that occurred on 07/01/2023. Client #1 (see LIC811 dated 07/10/2023) left the facility on 07/08/2023 without permission and has not returned since that time. Facility will contact this LPA when the client returns to the facility. There are no deficiencies to be cited on this date. A copy of this report is left with facility manager, Angelica Gamboa.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/11/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted a case management inspection for the above facility. Met by Human Resource Manager Jodee Romero. The purpose of the inspection is to obtain further documentation of psychotropic medication training. Documents obtained. There are no deficiencies to be cited on this date. A copy of this report is left with Human Resource Manager, Jodee Romero.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/12/2024, Licensing Program Analyst (LPA) Tamara Melikian travelled to the above facility to conduct an Annual inspection. Met by Administrator Joanna Solorio. At 11:30AM, an inspection of the physical plant was conducted. LPA observed adequate food supply, adequate bedding, storage space, activity space, hot water that measured 108 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 11:50AM, an inspection of client files was conducted as well as the centrally stored record and medications. At 12:15PM, an interview of S1 and C1 (see LIC811 dated 03/12/2024) was conducted. At 12:35PM, staff records were inspected. The exit interview was conducted at 1:15PM and a copy of this report given to the Administrator. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program(LPA) Corina Carrillo conducted a case management inspection April 23, 2024 at 10:00AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 6 out of Direct Care Staff and 1 out 1 of youth files were reviewed. 2 out of Direct Care Staff and 0 out of 1 youth were interviewed. (See the Confidential Names List, LIC 811, April 23, 2024.) The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments and crisis intervention plans, the licensee uses trauma- informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Carrillo observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Joanna Solorio.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/20/2024, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management for the above facility. Met by Administrator Joanna Solorio. On 05/14/2024, this LPA received the written report of an incident that occurred on 05/05/2024. The incident and reporting requirements were discussed with Ms. Solorio. There are no deficiencies to be cited on this date. A copy of this report is given to Ms. Solorio, Administrator on this date.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analyst's (LPAs) Reyna Martinez and Melissa Renovato. LPAs met with Joanna Solorio, Administrator and inspected the facility, inside and out. LPAs provided the Administrator the entrance checklist and requested the necessary documents. Centrally stored medications are maintained in a locked closet in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors and carbon monoxide were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced December 2024. Individual beds were observed with appropriate clean linens and are in good repair. The facility is CARF Accredited through 01/31/2027, and Mental Health Program Approval through 04/09/2025. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 72 degrees. Hot water temperature measures 145 degrees and concerns have been addressed with the facility. Facility has cameras in the common areas. No firearms or weapons are allowed in the facility. Facility does not have a pool. LPAs reviewed the facility's disaster plan, sampled medication and reviewed facility logs. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 administrator, 1 house manager, 1 counselor, 10 direct care staff, and 1 mental health rehabilitation specialist. 5 staff files were reviewed and meet all regulatory requirements. 2 staff were available to be interviewed. 4 records of clients were reviewed. 2 clients were available for interview. Continued on LIC809-C.. A review of the Licensing Information System on March 4, 2025, indicates that all facility staff are associated to the STRTP had DOJ, FBI, and child abuse index check clearances. LPAs discussed the STRTP's Program Statement Updates to ILS Version 5. There are two deficiencies being cited on attached LIC809-D page, during this inspection. A copy of this report and appeal rights was left at the facility at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program(LPA) Corina Carrillo conducted a case management inspection July 17, 2025 at 10:00AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 6 out of Direct Care Staff and 3 out 3 of youth files were reviewed. 2 out of Direct Care Staff and 1 out of 3 youth were interviewed. (See the Confidential Names List, LIC 811, July 17, 2025.) The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments and crisis intervention plans, the licensee uses trauma- informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Carrillo observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Joanna Solorio.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Reyna Martinez met with Renee Accardo, Administrator (AD) to conduct an unannounced case management inspection in response to an incident reported to LPA on 12/29/2025 by Client #1 during confidential interviews. During confidential interviews Client #1 (See LIC 811 dated 12/29/ Confidential Names List) reported an incident concerning Staff #2. LPA spoke with AD regarding incident. LPA gathered additional details and supporting documentation was provided to LPA. LPA requested for a formal incident report to be completed and submitted to LPA, upon the STRTP's completed behavioral report for #1 for the referenced incident. The STRTP will continue to monitor all the clients in care. Based on the LPA's record reviews and interviews, no deficiency is being cited today. A copy of this report is left with Renee Accardo, Administrator (AD).

met_with: Renee Accardo


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 11/10/2021, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 11:00AM. During the inspection, LPA met with Joanna Solorio, Administrator and Nancy Hernandez, Child Care Counselor I and inspected the facility inside and out. LPA reviewed two children's records and reviewed two staff personnel records for the facility. A medication count was conducted at 11:30AM. LPA interviewed two staff at 12:00PM. LPA did not interview any children in the home as the dependents were at school at this time. LPA conducted exit interview with Joanna Solorio, Administrator at 12:30PM. LPA provided the summary report to Joanna Solorio, Administrator upon completion.

Deficiencies:
80087(a): 1
2
3
4
5
6
7

met_with: Joanna Solorio, Nancy Hernandez

title:
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2
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6
780087(a) Buildings and Grounds. 	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:
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7


summary: Facility Evaluation

raw_content:
Narrative:
On July 5, 2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection. Met at the facility by Administrator Joanna Solorio. The purpose of the inspection is to issue a notice of deficiency for incidents reported to law enforcement on March 5, 2023 that were not reported to Community Care Licensing. Deficiency on the attached page. A copy of this report is given to Joanna Solorio, Administrator.


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Odayls Reynoso Diaz, House Manager (HM). The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff did not follow proper discharge procedures of youth; Staff did not ensure youth was provided reasonable accommodations to visit with family; Staff does not provide adequate supervision to prevent youth from conducting unsafe activities; and Staff did not ensure youth's personal grooming needs were met. LPA conducted interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Vanessa Galvan LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Odayls Reynoso Diaz, House Manager (HM). The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff member emotionally abused minor in care; and Staff member did not accord privacy to minor in care. LPA conducted interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Vanessa Galvan LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, an unannounced annual inspection was conducted by Licensing Program Analyst (LPA) Reyna Martinez at the Promesa Barstow House (STRTP). LPA met with Odalys Reynoso Diaz, Child Care Worker III (S1) and inspected the facility, inside and out. LPA provided S1 the entrance checklist and requested the necessary documents. Centrally stored medications are maintained in a locked closet in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors and carbon monoxide were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced December 2025. Individual beds were observed with appropriate clean linens and are in good repair. The facility is CARF Accredited through 01/31/2027, and Mental Health Program Approval through 04/09/2025, and are awaiting a response from DHCS. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 73 degrees. Hot water temperature measures 120 degrees. Facility has cameras in the common areas. No firearms or weapons are allowed in the facility. Facility does not have a pool. LPA reviewed the facility's disaster plan, sampled medication and reviewed facility logs. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 administrator, 1 house manager, 1 counselor, 8 direct care staff, and 1 mental health rehabilitation specialist. Continued on LIC809-C.. staff files were reviewed and meet all regulatory requirements. 2 staff were available to be interviewed. 4 records of clients were reviewed. 2 clients were available for interview. A review of the Licensing Information System on April 07, 2026, indicates that all facility staff listed on the LIC 500 under Promesa Barstow House are associated to the STRTP had DOJ, FBI, and child abuse index check clearances. A copy of this report was left at the facility at the conclusion of the inspection.


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection at Promesa Barstow House, STRTP, and met with Odalys Reynoso Diaz, Child Care Worker III. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted confidential interviews and record review which included photos and videos of the incidents, it was determined that staff did not prevent youth from engaging in appropriate behaviors with other youth; and Staff did not prevent youth from engaging in physical confrontations with other youth. Based on the LPA's observations, confidential interviews and records review, the preponderance of evidence standard has been met, therefore, the above allegations are found to be substantiated. A deficiency is being cited for the Interim Licensing Standards (ILS) Chapter 7.5, Version 5, Articles 1-10, Section87065.2(b)(1) PERSONNEL DUTIES. A copy of the report and Appeal Rights was provided to the STRTP. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Vanessa Galvan LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: PROMESA, BARSTOW HOUSEFACILITY NUMBER: 107200789


facility_name: PROMESA, MADERA HOUSE

raw_content:
Investigation Findings:
13On 12/02/2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint investigation for the above facility. Met by Residential Program Director Arlene Vargas. Interviews conducted and information and documents obtained. Based on interviews conducted and information obtained, there are conflicts in whether the facility staff refused to pick up the client (see LIC811 dated 12/02/2022) when the client was ready to leave the hospital. Based on the above, the complaint is Unsubstantiated. There are no deficiencies to be cited on this date. A copy of this report is given on this date to the Residential Program Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Tamara Melikian LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2


raw_content:
Investigation Findings:
13On 07/10/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint investigation for the above facility. Met by Administrator Renee Accardo. Confidential Interviews conducted and information and documents obtained. Based on confidential interviews conducted and information obtained, there are conflicts. Based on the above, the complaint is Unsubstantiated. There are no deficiencies to be cited on this date. A copy of this report is given on this date to the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Tamara Melikian LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


raw_content:
Investigation Findings:
13On December 3, Licensing Program Analysts (LPAs) Sonia Sanchez and Miriam Flores conducted a complaint investigation and met with Mickey Giannobile, House Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging staff did not prevent a minor from engaging in inappropriate sexual behavior with another minor. LPA conducted confidential interviews and obtained doucmentation. There were inconsistencies in the interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report, as well as the appeal rights were left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Sonia Sanchez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Mickey Giannobile


raw_content:
Investigation Findings:
13On 10/15/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection for the Promesa, Madera House STRTP for the purpose of informing the facility of the outcome of the investigation. Met by Administrator Mary Krahn. During the course of the investigation, LPA conducted interviews with the minor (#1) and a witness. Based on interviews conducted, the minors are allowed to attend church, however at times when the minors have not given notice they would like to attend, there has not been the inappropriate amount of staff. Based on the above, the allegation is unsubstantiated. Exit interview conducted and a copy of the report was given to the Administrator. There are no deficiencies to be cited on this date. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Tamara Melikian 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: 2 of 2

met_with: Mary Krahn


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection regarding an incident that occurred on April 13, 2021 with client (#1). Due to restrictions of COVID-19, this inspection was conducted by teleinspection with a copy of this document scanned to the Administrator with a request for signature. Met by Administrator Tamara Black. Client (#1) left the facility without permission and was located by law enforcement. After being located, client (#1) informed law enforcement of her real name, date of birth and social security number. Law enforcement ran the information and received confirmation with a photo identification that client (#1) was 21 years old and should not be in placement. Client's (#1) social worker was contacted who advised the facility to let client (#1) leave and they would close the bed on the date notified. Client (#1) left the facility with her belongings and the bed was closed. The report from law enforcement will be requested by this LPA. There are no deficiencies to be cited on this date.

met_with: Tamara Black


summary: Facility Evaluation

raw_content:
Narrative:
On 05/03/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection regarding an incident that occurred on April 13, 2021 with client (#1). Due to restrictions of COVID-19, this inspection was conducted by teleinspection with a copy of this document scanned to the Administrator with a request for signature. Met by Administrator Tamara Black. As a follow up to a case management conducted by this LPA on 04/29/2021, the report from law enforcement was received and confirms that client (#1) had a different name and date of birth than thought when placed with the facility. The information confirms that client (#1) is an adult and that law enforcement spoke with the county social worker who advised law enforcement and the facility to let the client leave at that time. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced annual inspection of staff records and training for the above facility. The inspection was conducted at the corporate offices of Promesa Behavioral Health. Met at the offices by Human Resources Personnel Jodee Romero and Residential Program Director Arlene Vargas. An inspection of staff records and training was conducted. A review of staff records on 09/02/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. The annual inspection will be completed at a later date. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On October 5, 2021, Licensing Program Analyst (LPA) Tamara Melikian conducted a follow up annual inspection at the above facility. Met by Administrator Tamara Black. At 1:30PM, an inspection of the physical plant was conducted. LPA observed adequate food supply, appropriately maintained and fenced pool, adequate bedding, storage space, activity space, hot water that measured 112 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 2:00PM, an inspection of client files was conducted as well as the centrally stored record and medications. At 2:45PM, an interview of S1 (see LIC811 dated 10/05/2021) was conducted. At 3:30PM, a interview of C1 (see LIC811 dated 10/05/2021) was conducted. The exit interview was conducted at 4:00PM and a copy of this report given to the Administrator. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Britanee Windom and Licensing Program Analyst Corina Carrillo conducted a Case Management Inspection on October 26, 2021 at 11: AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code Section 1538.7. 4 out of Direct Care Staff and 3 out of 3 youth files as identified on the LIC Confidential Names dated October 26,2021, were reviewed. 2 out of the Direct Care Staff and 3 out of 3 youth were also interviewed. The Plan of Operation including policies and procedures were reviewed. A copy of this report was discussed and provided to Tamera Black, Administrator.

met_with: Administrator Tamera Black


summary: Facility Evaluation

raw_content:
Narrative:
On March 28, 2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an annual inspection at the above facility. Met by Administrator Tamara Black. At 9:00AM, an inspection of the physical plant was conducted. LPA observed adequate food supply, appropriately maintained and fenced pool, adequate bedding, storage space, activity space, hot water that measured 108 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. At 9:30AM, an inspection of client files was conducted as well as the centrally stored record and medications. At 10:00AM, an interview of S1 and S2 (see LIC811 dated 03/28/2022) was conducted. At 10:30AM, a interview of C1 (see LIC811 dated 03/28/2022) was conducted. At 11:00AM, an inspection of staff records was conducted. The exit interview was conducted at 12:00PM and a copy of this report given to the Administrator. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts Michelle Kyane and Corina Carrillo conducted a case management inspection on July 26, 2022 at 11:00AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 2 out of Direct Care Staff and 4 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, dated July 26, 2022. The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Carrillo and LPA Kyane observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Mary Krahn


summary: Facility Evaluation

raw_content:
Narrative:
Complaint Specialist C.K. Kinney(CS) traveled to Promesa Madera House and met with Mickey Giannobile to conduct Collateral Inspection. Purpose of the inspection is to interview client for complaint investigation at a prior placement. CS conducted confidential interview. No deficiencies observed or cited during this inspection. Copy of this report left at the agency at conclusion of inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/22/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection for the above facility. Met by Facility Manager Mickey Giannobile. Administrator Renee Accardo was contacted by telephone. The purpose of the inspection is to interview a client #1 (see LIC811 dated 06/22/2023)for an incident that occurred on June 18, 2023. Client #1 refused to be interviewed on this date. A copy of this report is left with Facility Manager Mickey Giannobile. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/10/2023, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection to conduct a physical plant inspection. Met at the facility by Administrator Renee Accardo. Physical plant inspection conducted. The hot water measured at 105 degrees, however the Administrator advised that it will still be turned up slightly. There are no deficiencies to be cited at this time. A copy of this report is left with Administrator Renee Accardo.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Tamara Melikian and Reyna Martinez on February 13, 2024 at 10:00AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPAs met with Renee Accardo, Administrator and inspected the facility inside and out. LPAs reviewed 2 child's records and 2 staff personnel files on site at the facility. LPAs reviewed 2 child's psychotropic medications and medication records at the facility. LPAs interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed 0 children as one was at school and one was ill on this date. Interviews will be conducted at a later date. LPAs provided a copy of the licensing report to Renee Accardo, Administrator. No deficiencies are being cited at this time. LPAs conducted exit interview with Renee Accardo, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/23/2024, Licensing Program Analyst (LPA) Tamara Melikian conducted a follow up case management inspection-medications to interview client #1 (see LIC811 dated 02/23/2024). Met at the facility by CCW 1, Savy Ramos. Interview conducted of client #1 (see LIC811 dated 02/23/2024). There are no deficiencies to be cited on this date. A copy of this report is left with CCW1, Savy Ramos.

met_with: Savy Ramos