raw_content:
Narrative:
It was reported that lack of care and supervision by facility staff resulted in client endangering themself. It was reported that C1 expressed that they wanted to go to Mexico to get pregnant and join a cartel. It was reported that C1 continued to express their desire to go to San Ysidro for a community outing. It was further reported that staff drove C1 to San Ysidro and, while there, C1 stated they were feeling rebellious and wanted to be homeless. It was reported that C1 walked from a San Ysidro park through the international border to Tijuana where C1 exhibited aggressive behavior that was life threatening to self and others. Confidential interview indicated C1 was on a Community Integration plan where van rides and outings to outdoor spaces were allowed. Confidential interviews indicated S1 contacted S6 over the phone and inquired about an approved outing. Confidential interviews indicated the movie theater was given as a choice; however, according to confidential interview, there was not enough funding for the movie theater. Confidential interviews confirmed four staff took C1 on an afternoon outing. Confidential interviews indicated C1 was very adamant about going to the park, specifically in the San Ysidro community. Confidential interviews indicated S2 and S4 were not comfortable going to the park in that community due to the fact of it being close to the international border. Confidential interviews indicated S1 directed S2 to drive toward that direction and a park could be chosen when near the area. Confidential interviews indicated C1 was anxious during the drive. Confidential interviews indicated staff and client arrived in San Ysidro and C1 was taken to use the restroom at an indoor store. Confidential interviews indicated staff and client went to the park where C1 played for some time, stated they were bored, and asked to use the restroom again. Confidential interviews indicated S1, S2 and S4 accompanied C1 to the bathroom and went into the handicap stall. Confidential interviews indicated, while in the stall, C1 reported feeling rebellious and not wanting to return to the facility. Confidential interviews indicated staff reminded C1 of the positive opportunities and possibilities the facility offered. Confidential interviews indicated C1 was not receptive but did not show any concerning physical signs. Confidential interviews indicated C1 wanted to go on a walk during which staff attempted to verbally redirect C1. Confidential interviews indicated C1 walked out of the bathroom and began walking through a field to the sidewalk. Confidential interviews indicated C1 led the walk, continuing to cross streets, and ignoring staff's instruction to change direction. Confidential interviews indicated C1 and staff had walked about 20 minutes or a mile from the park. Confidential interviews indicated staff became aware they were walking in the direction of the border and S2 went back to the park to get the van. Continued.... It was reported that facility staff did not follow client's Individual Behavior Support Plan. It was reported that facility staff should have utilized the Individualized Emergency Intervention Plan (IEIP) that included procedures for how to maintain care, supervision, and safety of C1 in instances of imminent danger of serious injury to self or others. Confidential interviews indicated S1, S3, and S4 were within distance of the international border. Confidential interviews indicated S1 called management by phone and S4 attempted to receive help from security agents. Confidential interviews indicated C1 became aware of staff talking with security and ran through the revolving door with metal security bars into Mexico. Confidential interviews indicated S1 and S4 went through the revolving door after C1; however, C1 was nowhere in sight. Confidential interviews indicated S1 and S4 located C1 and redirected C1 to go back to the facility, to which C1 agreed. Confidential interviews indicated S6 arrived at the location where staff and C1 were, and S6 conducted a redirection technique and attempted with S1 to place C1 in a hold which resulted in C1 becoming combative. Confidential interviews indicated C1 began yelling and drawing attention to themself. According to confidential interviews, staff and C1 were transported back to the border, crossed the border back into the United States, and C1 was taken by emergency medical transport on a 5150 hold to a local hospital. Confidential interviews and record review indicated staff (S1-S4) did not use emergency interventions consistent with the client's emergency intervention plan. Confidential interviews indicated any staff member can initiate a hold if they see the need for it. Confidential interviews and record review indicated an approved hold should have been initiated when C1 began walking away from the park, as staff were aware of C1's expressed interest in escaping to Mexico and engaging in unsafe activities. Based on confidential interviews and records reviewed, the allegations of lack of care and supervision by facility staff resulted in client endangering themself and facility staff did not follow client's Individual Behavior Support Plan are SUBSTANTIATED because the preponderance of the evidence standard has been met. This posed an immediate health, safety, or personal rights risk to youth in care. The facility is being cited for violation of Title 22, Division 6, Section 80078(a) Responsibility for Providing Care and Supervision and Title 22, Division 6, Section 84300(c) General Provisions. [See Lic9099d]. An exit interview was conducted and plan of correction was developed with Devante Fields, Program Administrator. A copy of this signed report, LIC 9099D, LIC 811, and appeal rights were provided to Devante Fields, Program Administrator.

Investigation Findings:
13On October 8, 2025 at 10: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Devante Fields, Program Administrator to discuss the investigative finding for the allegations noted above. LPA Jauregui conducted an inspection of the facility on May 21, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed eight staff (S1-S7, S9). LPA attempted to interview one client (C1), however, after numerous attempts LPA was unsuccessful. Pertinent documents were obtained. On May 16, 2025, Community Care Licensing (CCL) received allegations that lack of care and supervision by facility staff resulted in client endangering themself and facility staff did not follow client's Individual Behavior Support Plan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 10/08/2025

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

met_with: Devante Fields, Program Administrator


state: CA

facility_name: YAI MORRO RD. EBSH

summary: Facility Evaluation

raw_content:
Narrative:
On January 17, 2023 at 10: AM, Licensing Program Analyst (LPA) Marisol Lopez arrived at Yai Morro Rd. Enhanced Behavioral Support Home (EBSH). LPA met with applicants Regional Deputy Director Elizabeth Steffens, Assistant Director Dana Simon, VP Program Development Sandra Speiser, Qualified Behavioral Modification Professional and Registered Behavior Technician who led a tour of the home. The purpose of the inspection is to conduct the pre-licensing inspection. The home was toured inside and out with the applicants. Applicants are applying for a maximum capacity of four clients. The home is requesting to be approved for 2 ambulatory clients and 2 non-ambulatory clients clients age 1-17 and is pending fire clearance approval. The home is a one-story residence with four bedrooms and two bathrooms. The home will serve four clients between the age of 12-17 years old. Bedroom # The room consists of a twin-size bed, dresser, night stand, desk and closet space. It sleeps one client- vacant. Bedroom # The room consists of a twin-size bed, dresser, night stand, desk, and closet space. It sleeps one client- vacant Bedroom # The room consists of a twin-size bed, dresser, night stand, desk, and closet space. It sleeps one client- vacant Bedroom# The room consists of a twin-size bed, dresser, night stand, desk, and closet space. It sleeps one client- vacant. Bedrooms were arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. There is sufficient linens, blankets, towels and pillows. The smoke detectors and carbon monoxide detectors were checked and were working properly. There are two fire extinguisher's in the home, one is located by entrance and one in the staff office, and both have a current inspection tag. Office will remain locked and staff/client files will be kept on site. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in medication room. Cleansers/chemicals were locked and stored in a locked cabinets. In laundry room is equipped with washer, dryer and locked cabinets for chemicals. Outdoor storage will have emergency supply back pack, extra PPE and extra daily supplies. There is a small refrigerator in locked medication room for refrigerated medications. Sharp knives were inaccessible and stored in the locked kitchen drawer. First Aid kit was accessible and had all required items including the thermometer. There are no weapons allowed at the facility as stated by the regional deputy director. The hot water temperature was tested and noted to be at 105 degrees. Applicants understands that the water temperature must be maintained within the regulation range of 105-120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan and visitation policy were posted. The backyard was observed to be clean and free of hazards. The facility has two doors with 30 seconds delayed egress. LPA verified and confirmed the delayed egress doors were functional during the inspection. The facility had the emergency intervention plan and emergency evacuation procedures in place. LPM completed the component III Orientation and discussed Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. Based on this inspection, the fire clearance and program administrator are pending. Once completed, the request of License will be forwarded to Licensing Program Manager for final approval and pending the Department of Developmental Services Certificate of Program Approval. An Enhanced Behavioral Supports Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services, has been received in accordance with Health and Safety Code section 1567.62. Exit interview conducted and a copy of this report was discussed and provided to applicant.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Dana Simon


summary: Facility Evaluation

raw_content:
Narrative:
On June 6, 2023 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at Yai Morro Rd. Enhanced Behavioral Support Home (EBSH) to conduct a post licensing inspection. LPA met with Esther Bomar-Franks, Lead who provided LPA with a guided indoor and outdoor tour of the facility.The home will serve four clients between the age of 12-17 years old. The facility is a one-story residence with four bedrooms and two bathrooms. The facility consists of living room, kitchen, dining area, staff office, staff bathroom, sensory room, and shed. Bedrooms one through four consist of a twin-size bed, dresser, night stand, desk and closet space. Beds were observed to have appropriate linen and mattress in good repair. Bedrooms were arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. There is sufficient linens, blankets, towels and pillows. The living room is furnished with couches and a television. The kitchen was observed to be free from observable hazards. Meal menu was observed on the refrigerator. A physical plant inspection was completed and included the following checks: Facility is a fenced perimeter and has two doors with 30 seconds delayed egress.. The smoke detectors and carbon monoxide detectors were checked and were working properly. There are two fire extinguisher's in the home, one is located by entrance and one in the staff office, and both have a current inspection tag. Office will remain locked and staff/client files will be kept on site. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in medication room. Continued..... Cleansers/chemicals were locked and stored in a locked cabinets. In laundry room is equipped with washer, dryer and locked cabinets. There is a small refrigerator in locked medication room for refrigerated medications. Sharp knives were inaccessible and stored in the locked kitchen drawer. First Aid kit was accessible and had all required items including the thermometer. There are no firearms at the facility as stated by the administrator. The hot water temperature was measured and noted to be at 114 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan and visitation policy were posted. An exit interview was conducted and copy of this report was provided to Portia Tresvant, Administrator.

met_with: Esther Bomar-Franks, Lead


summary: Facility Evaluation

raw_content:
Narrative:
On April 26, 2024 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at Yai Morro Rd. Enhanced Behavioral Support Home (EBSH) to conduct an annual inspection. LPA met with Devante Fields, Lead and Mitchell Blackwood, Assistant Director who provided LPA with a guided indoor and outdoor tour of the facility. The home serves clients between the age of 12-17 years old. The facility is a one-story residence with four bedrooms and two bathrooms. The facility consists of living room, kitchen, dining area, staff office, staff bathroom, sensory room, and shed. Bedrooms one through four consist of a twin-size bed, dresser, night stand, desk and closet space. Beds were observed to have appropriate linen and mattress in good repair. Bedrooms were arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The living room is furnished with couches and a television. The kitchen was observed to be free from observable hazards. A physical plant inspection was completed and included the following checks: Facility is a fenced perimeter and has two doors with 30 seconds delayed egress. The smoke detectors and carbon monoxide detectors were checked and were working properly. There are two fire extinguisher's in the home, one is located by entrance and one in the staff office, and both have a current inspection tag. All hazardous items have been properly made inaccessible to areas where children will have access. The medication was observed to be locked in medication room and First Aid kit was accessible and had all required items. Continued.... Cleansers/chemicals were locked and stored in a locked cabinets. The laundry room is equipped with washer, dryer and locked cabinets. There is a small refrigerator in locked medication room for refrigerated medications. There are no firearms at the facility as stated by the administrator. The hot water temperature was measured and noted to be at 119 degrees. Trash cans for storage of solid waste had tight fitting lids. LPA observed locked shed in the backyard of the facility. Sharp knives were inaccessible and stored in safe in the shed. LPA observed sufficient canned goods, snacks, sufficient emergency water, art supplies, books and emergency kits. LPA observed the following items posted: Personal Rights, Facility Sketch, Emergency Disaster Plan, Grievance forms, Ombudsman, Rights of Individuals with Developmental Disabilities, LIC 500, rainy day schedule, choice board activities, and visitation policy were posted. Client and staff files are maintained on site in the staff office. Staff office is remained locked at all times. LPA reviewed two out of two client files and five out of five staff files. LPA conducted two out of two staff interviews and zero client interviews. An exit interview was conducted and copy of this report was provided to Mitchell Blackwood, Assistant Director.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On August 8, 2024 at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced Case Management visit at the facility. The purpose of the Case Management visit is to issue an LIC 421FC Civil Penalty Assessment for a deficiency that was cited on July 24, 2024. Due to technical difficulties, an LIC 421FC was not generated during the visit in which the citation was issued. Wet signatures were obtained during today's visit. A hard copy of the signed LIC 421FC will be accessible in the facility file in the San Diego Regional Office. An exit interview was conducted. A copy of this report, along with copies of the LIC421FC and appeal rights were provided to Portia Tresvant, Administrator.

visit_type: Case Management

met_with: Portia Tresvant, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews reported that C1 is allowed to obtain any food they would like at any time. Confidential interviews stated that the food/snacks were not withheld from C1. Confidential interviews stated that no staff witnessed food/snacks being withheld and used as punishment for C1. LPA is unable to determine if there was a personal violation against C1. Based on inconsistent confidential interviews, the allegation that staff (S1) withheld food/snack from minor (C1) is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Briyanna Williams, Facility Lead.

Investigation Findings:
13On January 7, 2026, at 12: PM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an unannounced visit to YAI Morro Rd. Enhanced Behavioral Supports Home (EBSH) Group Home (GH) to deliver the investigative findings for the allegation listed above. On 05/21/2025, LPA Lucero Jauregui conducted a health and safety inspection at the GH, and no immediate health and safety hazards were observed. LPA Jauregui initiated the complaint at the GH, conducted interviews (S3), and obtained documents pertinent to the investigation. LPA Robinson conducted interviews with client 1 (C1) and staff (S1 and S4). LPA attempted to interview staff (S2 and S5) but was unsuccessful after multiple attempts. On 05/15/2025, Community Care Licensing (CCL) received an allegation that staff (S1) withheld food/snack from minor (C1). It was alleged that S1 had withheld food from C1 as a form of punishment. Confidential interviews denied that S1 withheld food from C1. (Continued on LIC 9099C...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Cynthia Robinson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 01/07/2026

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

report_type: Complaint Investigation

met_with: Briyanna Williams, Facility Lead

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived unannounced to YAI Morro and met with Portia Tresvant, Administrator. The purpose of this visit was to address a deficiency that was noted. On December 8, 2023, the Department became aware of unusual incidents of interactions between Foster Children (C1, C2). Based on interviews and record review, the Licensee did not ensure to notify Community Care Licensing (CCL) with a date, time , duration, location of the incident and the licensee did not provide CCL with a detailed narrative describing the incident. This posed an immediate Health, Safety, or Personal Rights risk to clients in care, the facility is being cited for a Type A violation of Reporting Requirements Reporting Requirements. (h) Incident Reports must include the following:(1) Date, time, duration and location of the incident. (2) A detailed narrative, describing the incident and the events leading up to incident. An exit interview was conducted, plan of operations was developed with Portia Tresvant, Administrator. A copy of this report along with appeal rights was provided to Portia Tresvant, Administrator.


raw_content:
Narrative:
investigation. When the allegation was discussed with C1, C1 was unable to articulate whether they remembered S1. Due to C1's inability to recall S1, LPA was unable to obtain pertinent information from C1 regarding the allegation. Additional confidential interviews indicated that S1 did not respond to LPA's attempts to communicate or requests for an interview. Based on the information obtained through confidential interviews, the allegation that staff spoke to a minor inappropriately may have occurred; however, there was not a preponderance of evidence to support the alleged violation. Therefore, the allegation is deemed unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was explained and provided to Administrator Devante Fields.

Investigation Findings:
13On 01/23/2026, at 10: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to YAI Morro Enhanced Behavior Supports Home (EBSH) and met with Administrator Devante Fields to deliver the investigative finding regarding the allegation listed above. On 07/08/2025, Community Care Licensing received an allegation that staff spoke to a minor inappropriately. On 07/17/2025, LPA L. Jauregi arrived at the facility to conduct a health and safety inspection and obtained pertinent documents. No immediate health and safety hazards were observed. During the visit, LPA Jauregi interviewed Staff 3 (S3), and LPA Choi interviewed Client 1 (C1). LPAs were not able to gather additional information. Regarding the allegation that staff (S1) spoke to minor (C1) inappropriately, it was reported that staff members frequently used profanity and told C1 to "be quiet" or "hush" when C1 was vocalizing or seeking attention. Confidential interviews indicated that S1 told C1 to "be quiet" or "hush" during these instances. Confidential interviews further reported that S1 was no longer employed at the facility at the time of the CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 01/23/2026

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

met_with: Devante Fields, Adminstrator


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
anesthesia that had not been pre-approved by C1's authorized representatives, including C1's relative, the San Diego Regional Center representative, and the San Diego County Social Worker. It was further reported that the facility allowed the dental procedure to take place on 07/01/2025. Confidential interviews reported that C1 has a known allergy to anesthesia. Interviews further indicated that the facility was not authorized to allow C1 to undergo any medical or dental procedure involving anesthesia without prior consent. Additional confidential interviews reported that Licensing was provided with C1's "Consent to Authorize Medical Treatment" form, which specified that C1's relative and/or county authorized representative must be notified prior to any medical procedure. Confidential interviews reported that the facility failed to notify C1's relative or county representative before C1 underwent the procedure under anesthesia. Confidential interviews further reported that facility administration attempted to attribute the miscommunication to Staff 1, a per-diem nurse. However, interviews indicated that facility administration was aware of C1's medical consent form, which clearly stated that, unless there is an emergency, anesthesia shall not be used on C1 unless a relative or guardian is present. Confidential interviews also reported that the Department requested documentation from the facility regarding C1's medical treatment authorization; however, as of this writing, the facility has failed to provide sufficient documentation to refute the allegation. Based on confidential interviews and a review of pertinent documentation, the preponderance of evidence standard has been met. The allegation that staff allowed C1 to undergo a medical procedure without authorization or consent from the responsible party is substantiated. The facility is being cited for a violation of Title 22, Division 6, Chapter 1, Article 8: Incidental Medical Services - Section 80092.1(n), General Requirements for Restricted Health Conditions, which states: "The licensee shall ensure that the client's health-related service needs are met and follow the approved plan for each client." (See LIC 9099D) An exit interview was conducted. A copy of this report (LIC 9099), deficiencies page (LIC 9099D) and appeal rights were explained and given to Administrator Devante Fields.

Investigation Findings:
13On 01/23/2026, at 10: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to YAI Morro Enhanced Behavior Supports Home (EBSH). LPA Choi met with Administrator Devante Fields to deliver the investigative finding related to the allegation listed above. On 07/10/2025, Community Care Licensing (CCL) received an allegation that facility staff allowed a child (Client 1, C1) to undergo a medical procedure without authorization or consent from the responsible party. On 07/17/2025, LPA Lucero Jauregi arrived at the facility, conducted a health and safety inspection, and obtained pertinent documentation. No immediate health and safety hazards were observed during the inspection. LPA Jauregi interviewed Staff 1 and Staff 3 (S1, S3). In addition, LPA Choi conducted interviews with Client 1 (C1), C1's Relative (REL), and the County Social Worker (CSW). Regarding the allegation that facility staff allowed C1 to undergo a medical procedure without proper authorization or consent, it was reported that C1 was scheduled to undergo a dental procedure requiring CONTINUED ON THE NEXT PAGE SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 01/23/2026

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

met_with: Devante Fields, Administrator

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On April 26, 2024 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at Yai Morro Rd. Enhanced Behavioral Support Home (EBSH) to conduct an annual inspection. LPA met with Devante Fields who provided LPA with a guided indoor and outdoor tour of the facility. The home serves clients between the age of 12-17 years old. The facility is a one-story residence with four bedrooms and two bathrooms. The facility consists of living room, kitchen, dining area, staff office, staff bathroom, sensory room, and shed. Bedrooms one through four consist of a twin-size bed, dresser, night stand, desk and closet space. Beds were observed to have appropriate linen and mattress in good repair. Bedrooms were arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The living room is furnished with couches and a television. The kitchen was observed to be free from observable hazards. A physical plant inspection was completed and included the following checks: Facility is a fenced perimeter and has two doors with 30 seconds delayed egress. The smoke detectors and carbon monoxide detectors have been inspected by the fire department and in working order. There are two fire extinguisher's in the home located in the medication room and staff office. All hazardous items have been properly made inaccessible to areas where children will have access. The medication was observed to be locked in medication room and First Aid kit was accessible and had all required items. Sharp knives were inaccessible and stored in a safe in the medication room. Continued.... Cleansers/chemicals were locked and stored in a locked cabinets. The laundry room is equipped with washer, dryer and locked cabinets. There is a small refrigerator in locked medication room for refrigerated medications. There are no firearms at the facility as stated by the administrator. The hot water temperature was measured and noted to be at 103.5 degrees Farenheit. Facility is advised water temperature should range from 105 to 120 degrees Farenheit. Trash cans for storage of solid waste had tight fitting lids. There are two storage sheds in the backyard used for storing activity supplies and hazardous chemicals. There is an additional shed used as a staff lounge/ break room. LPA observed sufficient canned goods, snacks, sufficient emergency water, art supplies, books and emergency kits. LPA observed the following items posted: Personal Rights, Facility Sketch, Emergency Hotline number and facility license. Client and staff files are maintained on site in the staff office. Staff office is remained locked at all times. LPA reviewed two out of two client files and five out of five staff files. LPA conducted two out of two staff interviews and zero client interviews. Based on today's file review and inspection, there are no deficiencies cited at this time. An exit interview was conducted and copy of this report was provided to Devante Fields, Administrator.


facility_name: CASITA REAL, INC

summary: Facility Evaluation

raw_content:
Narrative:
On September 8, 2025, at 1: PM, Licensing Program Analyst (LPA) Jacob Salem met with Applicants Julianne Dautin, Jhodee Quitevis, Paul Llamoso, and Nemia Atendido at the Community Care Licensing San Diego office for a Component II orientation. LPA went over application revisions and discussed the application process prior to licensure. LPA confirmed that a pre-licensing visit will be scheduled once the applicant secures control of property, receives clearance from the fire authority, and applicantion revisions are approved by the Department. The applicants stated that renovations are complete, and that they will be conducting a walk through of the property and review of lease before obtaining control of property within the next month. A signed copy of this report was provided to Julianne Dautin.


facility_name: GUARDIAN HOME, INC

summary: Facility Evaluation

raw_content:
Narrative:
On the date above a pre licensing visit was conducted at Guardian Home by Licensing Program analyst (LPA) Les Inouye. I was met by Licensee Paul Llamoso, Cherry Ann Agravante, Tara Marie Lacanilao, Julianne Datuin, Nemia Atendido. A review of the Physical Plant was conducted including the Indoor Activity Space, Fixtures Furniture Equipment and Supplies and Outdoor Activity Space. The indoor space is an open floor plan with not hazards. The outdoor area is fee of hazards. There is a utility shed in the back yard which was secured during the visit. Kitchen was clean and non-perishable items were observed in the kitchen and additional non-perishable items were observed in the pantry. Bedrooms were observed, 5 single occupancy and a capacity of five. All rooms were appropriately furnished with additional linens was observed and adequate space for medical equipment. All chemicals and cleaning supplies were locked and secured. Smoke Alarms and Carbon Monoxide detectors, fire suppression system was observed and operating. Hot water temperature was measured at 110 degrees. Back yard -there is no pool or hot tub, yard consisted of a lawn area. The physical plant review was observed to be clean, safe, and free of hazards. The physical plant has met standards. At this time the applicant is in the process to be set up with Guardian and access with a Guardian login. Applicant will notify LPA when approved. A new revision of the Review by CCL will be completed and submitted to LPA and will be reviewed.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On the date above a Case Management visit was conducted at Guardian Home by Licensing Program analyst (LPA) Les Inouye. I was met by Licensee Paul Llamoso, Cherry Ann Agravante, Tara Marie Lacanilao, Julianne Datuin, Nemia Atendido. The visit was to discuss corrections that were requested on the last review. Detailed discussions took place on several regulations, the format of the review and the required corrections. Guardian Home and LPA have a better understanding of required corrections and a revision will be submitted to the LPA once completed.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Les Inouye contacted Paul Llamoso by phone to discuss the application status. Paul advised LPA that he is out of the country and referred LPA to discuss the application with Tara Lacanilao. Paul texted Tara's phone number. LPA phoned Tara and left a voice mail message to call LPA, Number left to call back. I was able to talk to Tara and we discussed that the submission should be in by tomorrow. 3/28/25. We also discussed the Emergency Intervention Plan and review by a certified behavior analyst. She indicated that the facility is already working with someone who provides services for their other facilities. I provided Tara with a name of a behavior analyst, I came across who is an employee with Regional Center. Just a reminder that the information in the EIP section should be included in the training, Section 24. As always if there are any questions, please do not hesitate to contact me.

met_with: Tara Lancanilao


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Les Inouye Scheduled a Teleconference with Paul Llamoso of Guardian Home to go over the latest review of the Program Statement which was returned for updates and corrections on 05/23/25. Tara Lacanilo was designated to attend the meeting. During the meeting all issues identified on the review were covered. Tips to address each issue was discussed such as a Table of classes which is easier to provide required information. Also discussed was that each class must included identified required information. Tara stated that the EIP Section was currently under review by their Behavior Analyst. LPA advised to get a expected approved return date from the BCBA and inform LPA of when the EIP section can be returned for review. Tara explained that she has a scheduled call with the BCBA and will inform LPA of the status. At the end of the meeting Tara had no further questions and the meeting ended at that time.

met_with: Tara Marie Lacanilo


summary: Facility Evaluation

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Narrative:
A TEAMS meeting was called by Guardian Home to go over the latest Program Statement revision that was returned to Guardian Home on 7/21/25. The list of corrections was reviewed which consisted 3 sections, EIP Section 14 - Updated version deleted paragraph that had approved information in it. Asked to provide information that was previously approved. The discussion revolved around the use of CPI and or a BCBA to develop a training curriculum for staff training and the documentation for the training. Staff Schedule Section 21 - Related to missing information in Section In-service Training Section Tara expected to have the Program Statement returned to CCL with in two weeks. LPA offed to have Tara contact LPA via email, text or better call to discuss any issues. At that time the meeting ended.

met_with: Tara Lacanilo


summary: Facility Evaluation

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Narrative:
On the date above a Case Management visit was made at the Fresno Office with Licensing Program Analyst Les Inouye and Paul Llamoso, Tara Lacanilao and Julianne Datuin to discuss and go over the last return submission to Guardian Home Inc. Which was sent back to the licensee on 08/27/25. This meeting is to discuss in detail and have a conversation on the expectations of information that is to be submitted. This has been the 12th review of the Program Narrative. The discussed Program Narrative will also be used for the latest application submission for Robinwood Home. Once the current Program Narrative is approved the Program Narrative shave be revised to update any and all information that will now be used in the Robinwood Program. The issued discussed in at todays meeting are based on the requested items submitted on 08/27/25. All issues with were addressed on 08//27/25 were discussed line by line Additional items discussed include: use of the LIC500, Section Job Descriptions. Paul will submit the Program Narrative as a complete document and a review will be completed. LPA will review submitted Program Narrative and provide feedback or approve the Program Narrative. If the Program Narrative is approved including the Emergency Intervention Plan (EIP) the EIP can be presented to the Board of Directors and a resolution can be made to approve the EIP in accordance to 84322(k). The final review will include All Section A documents and any updated documents will be requested at that time.


summary: Facility Evaluation

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Narrative:
On 12/23/2025, an unannounced required Post Licensing inspection was conducted by Licensing Program Analyst (LPA) Les Inouye. LPA was met by Administrator Cherry Anne Agravante. An inspection of the facility was completed and the following was observed: 1. Hot water temperature measured within appropriate range @ 118 degrees. 2. All smoke detectors appeared to be in proper working condition. 3. Clients are on g-tubes but alternative food list was posted. 4. First aid kit stocked. 5. Medications locked and centrally stored. 6. Fire extinguishers properly charged. 7. Adequate indoor and outdoor activity space and activities observed. 8. Clients have adequate clothing and storage space. 9. Adequate supply of linens observed. 10. Sharps locked up securely. 11. Per Administrator, there are no weapons at the facility. 12. There are no pets at the facility. 13. There are no bodies of water at the facility. There have been no deficiencies cited since date of license. Staff and client files were reviewed and clearances verified. Facility uses Therap Comupter documentation, for clients. Physical files of staff and client files were reviewed. Administrator confirms that the exit door to Room 1 has been reported to Brilliant Corners for maintenance. The exit door due to weather sticks and makes it difficult to open and close. Facility to notify CCL when corrected.

met_with: Cherry Anne Agravante


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Group Home Special Health Care Needs (GHSHCN) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Cherry Anne Agravante. During the course of investigating the allegation, LPA conducted interviews with staff members, Board Members and witnesses, a record review and information was obtained. Board members denied all specific allegations that would be inimical to the operation of the facility. The interviews and information obtained revealed inconsistencies to the allegation. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye 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


facility_name: LIBERI HOME

summary: Facility Evaluation

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Narrative:
On 9/03/2024 at approximately 9: AM Licensing Program Analysts (LPAs) Tatyana Shulz, Sarina Buchannan, Zaria Turner, and Licensing Program Manager (LPM) Rosa Rodriguez made an announced visit with the purpose of conducting a pre-licensing inspection to the above facility. LPAs and LPM met with Administrator, Paul Fernandez, and a walk through of the interior and exterior was completed. Physical Plant LPAs and LPM entered from the front door into the Great Room that has 1 couch, 2 chairs, coffee table and a TV, with a closet housing their emergency food supply and water. There is a dining room with a table and 4 chairs next to the kitchen area. There are 5 bedrooms all of them equipped with 1 twin bed, 2 dressers, closet, TV, lamp, patient lift, trash cans with lids and a door with access to the backyard with an attached alarm system. Room 1 is an office area with a desk, closet, filing cabinets and the medication storage lockup. Room 2 is the multipurpose room with Big Jenga, connect 4 and have sufficient activities for clients, including books, age-appropriate toys, arts/craft materials and all furniture is in good repair. There are two full bathrooms and 1 half bathroom, with working toilets, and running warm water with a temperature of 105 degrees. The two full bathrooms are also equipped with a patient lift and there is 1 shower bed available. The backyard is gated, with ADA accessible ramps leading from each exit and room. There is a gazebo area with a table and 6 chairs. There is a generator located next to the table and the shed. The shed is stocked with chairs, tools, extra refrigerator, water, nonperishable food, storage bins, and extra cleaning supplies. On the back side of the shed the property has 14 trash bins. The facility has ordered a van to transport the clients and the information will be provided to the LPA once available. Report continues on 809-C. The following required documents were posted, Emergency Disaster Plan, Personal Rights and complaint contact numbers. Disinfectants/cleaning solutions are inaccessible to children in care and locked under the kitchen sink. Refrigerator temperature at or below 45 degrees F. Nonperishable foods one week and fresh perishable foods three days minimum. Water and fridge temperature posted on the front of the refrigerator. Sharp objects are locked in the drawer and there are containers to place leftover food. A working telephone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120-degree F. Fire Extinguishers are up to date and in working order. Toilets, wash basins and shower fixtures in good repair, there are no leaks and hot water is accessible. Soap and paper towels are available to clients. Bedroom required linen and furnishings are fully stocked. The facility is free of vermin. The generator and water valves located in the backyard area are easily accessible to clients in care. There is approximately a 5 foot L shaped fence surrounding the generator and the water valves can be easily reached from the walking path. If the population served changes those two areas will need to become inaccessible to clients. However, due to the population that the facility serves currently, the licensee will not need to be concerned with these changes, as of now. An exit interview was conducted with Administrator, Paul Fernandez and a copy of this report will be provided to the facility, the home is in full compliance.

met_with: Administrator- Paul Fernandez


summary: Facility Evaluation

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Narrative:
On February 19, 2026 at approximately 12: PM Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit with the purpose of conducting a post licensing inspection to the above facility. LPA met with Janna Kirtley, Registered Nurse (RN), and a walk through of the interior and exterior was completed. LPA entered from the front door into the Great Room that has 1 couch, 2 chairs, coffee table and a TV, with a closet housing their emergency food supply and water. There is a dining room with a table and 4 chairs next to the kitchen area. There are 5 bedrooms, all of them equipped with 1 twin bed, 2 dressers, closet, TV, lamp, patient lift, trash cans with lids and a door with access to the backyard with an attached alarm system. Room 1 is an office area with a desk, closet, filing cabinets and the medication storage lockup. Room 2 is the multipurpose room with sufficient activities for clients, including books, age-appropriate toys, arts/craft materials and all furniture is in good repair. There are two full bathrooms and 1 half bathroom, with working toilets, and running warm water with a temperature of 116 degrees. The two full bathrooms are also equipped with a patient lift and there is 2 shower beds available. The backyard is gated, with ADA accessible ramps leading from each exit and room. There is a gazebo area with a table and 6 chairs. There is a generator located next to the table and the shed. The shed is stocked with tools, an extra refrigerator, water, electric appliances, storage bins, and extra cleaning supplies. There is a Ford Transit in good repair available to transport clients. Report continues on 809-C. The following required documents were posted, Emergency Disaster Plan, Personal Rights and complaint contact numbers. Disinfectants/cleaning solutions are inaccessible to children in care and locked in the laundry area and under the kitchen sink. Refrigerator temperature is at or below 45 degrees F. With the temperature log posted on the front of the refrigerator. Food menu is posted. Nonperishable foods one week and fresh perishable foods three days minimum. Sharp objects are locked in a drawer next to the oven. A working telephone is available at the facility. First Aid Kits are fully stocked. Hot Water is between 105-120 degree F. Fire Extinguishers are up to date and in working order. Toilets, wash basins and shower fixtures are in good repair, there are no leaks and hot water is accessible. Soap and paper towels are available to clients. Bedroom required linen and furnishings are fully stocked. The facility is free of vermin. LPA reviewed 5 staff files and 3 client files, there is no Care Tool available for this facility and inspection type. An exit interview was conducted with Jennifer Kennedy, RN and a copy of this report will be provided to the facility, the home is in full compliance.

met_with: Jennifer Kennedy- Registered Nurse


facility_name: ROBINWOOD HOME

summary: Facility Evaluation

narrative: On the date above a Case Management visit was made at the Fresno Office with Licensing Program Analyst Les Inouye and Paul Llamoso, Tara Lacanilao and Julianne Datuin to discuss and go over the last return submission to Guardian Home Inc. Which was sent back to the licensee on 08/27/25. This meeting is to discuss in detail and have a conversation on the expectations of information that is to be submitted. This has been the 12th review of the Program Narrative. The discussed Program Narrative will also be used for the latest application submission for Robinwood Home. Once the current Program Narrative is approved the Program Narrative shave be revised to update any and all information that will now be used in the Robinwood Program. The issued discussed in at todays meeting are based on the requested items submitted on 08/27/25. All issues with were addressed on 08//27/25 were discussed line by line Additional items discussed include: use of the LIC500, Section Job Descriptions. Paul will submit the Program Narrative as a complete document and a review will be completed. LPA will review submitted Program Narrative and provide feedback or approve the Program Narrative. If the Program Narrative is approved including the Emergency Intervention Plan (EIP) the EIP can be presented to the Board of Directors and a resolution can be made to approve the EIP in accordance to 84322(k). The final review will include All Section A documents and any updated documents will be requested at that time.


summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analyst (LPA) Les Inouye travelled to the facility listed above to conduct a prelicensing inspection. The application, Plan of Operation and Program statement are under review. Corrections were requested from the licensee. Licensee is in conference with CVRC for the use and placement options. Licensee will notify CCL is there is to be a change in license. 1. Facility Grounds are clean and free of debris or observable hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locke\able and centrally stored medications location was observed. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual hospital beds were observed in good repair, with clean mattresses and pillows observed. Individual beds were observed with appropriate clean linens. Adequate supply of additional bedding and linens observed. 8. The house is a 5 bedrooms, single occupancy located on a single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods to be in place prior to accepting clients. 10. Weekly menu posted and accessible to clients. 11.Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has 2 full bathrooms in the house for client use, both are operable with roll in shower 13. Appropriate forms posted in view of facility clients. 14.Facility has no pool . 15.No firearms or weapons are allowed in the facility. Issues to be corrected 1.Water heaters on both side the house shall be secured. 2. exterior floor plan to be updated to include fenced area next to garage 3. Evacuation map to be updated to include fenced area next to garage.

met_with: Paul Llamoso, Stacyrae Agusto, Nemia Atendido, Kaycee Huertas


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Leslie Inouye initiated an inspection at the Group Home (GH) and met with Paul Llamoso. The purpose of the inspection was to follow up on information to be corrected at the Prelicenisng Inspection. LPA reviewed water heater enclosures on both sides of the house and the back yard facility sketch and evacuation map. LPA reviewed enclosures and walked through the issues of the yard facility sketch and evacuation map. Based on information reviewed locks will be installed on the water heater enclosures and a gate from between the garage and the evacuation gate exiting to Robinwood Lane will be added on the map. Pictures of the water heater locks will be submitted and revised yard sketch/Evacuation map will be emailed for review. Once these issues are addressed the application will be reviewed for approval. Licensee will be notified after final review.

met_with: Paul Llamoso


facility_name: 2 LOVING HEARTS

summary: Facility Evaluation

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Narrative:
On August 23, 2023, Licensing Program Analyst (LPA) Demetris Teal and Licensing Program Manager (LPM) Tira Logan-Shanks conducted a Component II- in person meeting at the Monterey Park Regional Office. The following was present; Terrobin Phillips President of Loving Hearts facility. LPA and LPM discussed their application and program statement advising of the following corrections. The following information must be completed and submitted to Licensing: Section A Board of Resolution Authorizing Individual(s) to applying on behalf of the Board of Directors: who is Deesha Inc? Who are the members of Deesha Inc.? Who was present for the vote on March 1, 2023, where it was decided that Terrobin Phillips is authorized to represent and act on behalf of Loving Hearts? Why doesn't it say Loving Hearts LLC as the "members"? LIC 308 lists "TBH" as the person designated in the absence of the facility administrator. A name needs to be specified. LIC 309 list a president as N/A, yet the board of resolution names a president. Statement of Information on the Secretary of State website shows Keisha Law as a Manager or Member, but she is not listed on the LIC 309. LIC 400 needs a signature. Articles of Organization is not submitted. LIC Surety Bond needs to list LLC as the applicant. Continued... .....Continued LIC Personnel Report needs to be completed. D signed by Terrobin Phillips is not for Community Care Licensing (CCL). C is needed. 9282 signed by Terrobin Phillips is not for Community Care Licensing (CCL). LIC Health Screening Report needs to have the updated T.B tests. Program Statement needs to be followed per CCL template. Administrator currently has full time employment outside of the Group Home setting. Application shows proof of Adult Care Certification only. Discussed with president what is required for the Program Statement in detail. Program Statement details regarding tabs and information, where to look for Title 22 regulations, Interim Licensing Standards and make sure the Program Statement coincides with all regulations. President agreed to submit all information discussed and required by September 1, Exit interview conducted. A signed copy of this report was provided to the applicant along with Notice of Incomplete Application.

met_with: Terrobin Phillips


summary: Facility Evaluation

raw_content:
Narrative:
On October 3, 2023, Licensing Program Analyst (LPA) Johanna Lofton conducted an announced visit at Loving Hearts Group Home with the purpose of conducting a pre-licensing inspection. This facility will accommodate Regional Center Clients between the ages of 11-17. LPA Lofton met Facility Administrator Terrobin Phillips and Facility Manager Kiesha Law and together conducted a walk through of the facility. The facility is a one level house located in a residential area. The facility consist of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining room, garage and backyard. The master bedroom will be used as an office which is equipped with a desk, computer and office supplies. The other two bedrooms are for the clients. These bedrooms are equipped with two (2) full beds each, dressers and closet space. At the time of the inspection, all utilities (gas, water, electricity) were on. The fire alarm was tested and it was in working conditions. LPA Lofton observed nonperishable food in the fridge, freezer and pantry. There is a fire extinguisher located in the kitchen by the door leading to the backyard. Additional linen and an extra refrigerator/freezer were observed in the garage along with washer and dryer. There is a cabinet in the garage which will contain: sharps, cleaning supplies and anything toxic that will pose a risk to the clients. This cabinet will be kept locked at all times. LPA observed the outdoor of the home to be clean and free of debris and/or obstructions. There is a fully stocked first aid kit located in the office area. There were no corrections observed to be made prior to the facility being licensed. Exit interview was conducted and a copy of this report was emailed to the above mentioned administrator.

met_with: Terrobin Phillips- Administrator


summary: Facility Evaluation

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Narrative:
On August 2, 2024 at 11: A.M.., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Post Licensing visit at the above named facility. LPA met with Kaiesha Law- Facility Manager. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 12 to 17. The facility serves ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There are currently no clients or staff at the facility. The LPA requested the following: Board of Director Meeting Minutes. The facility is a single-story home with 3 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with one (1) toilet in each. There are no firearms or ammunition in the facility. There are no bodies of water on the facility premises. At 11: P.M., LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a cabinet located in the garage. Sharps/knives are inaccessible and stored in a locked cabinet in the kitchen. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked cabinet in the kitchen. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. Room temperatures are maintained at 75 degrees F. The hot water temperature was tested and measured at 110 degrees F. All sinks, showers and toilets are in working order. No children are in care. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Continued.... ...Continued Adequate supply of beddings and linens were observed. Overall, facility is clean, safe, sanitary and in good repair. Operations There are no clients or staff at the facility. The board of directors are not currently conducting meetings. and will start to meet month. License is posted in a prominent location Disaster Preparedness Plan Facility maintains a current 610C. Written disaster and mass casualty plan of action will be provided and available at the facility. There are currently no clients or staff at the facility Emergency Intervention Plan Facility does not use manual restraints. Facility manager and administrator have not had restraint training and will take classes. There are currently no clients or staff at the facility Client Records There are currently no clients in care Staff Records There are currently no staff at the facility. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (1) staff. Citations were issued during this inspection.

met_with: Kaiesha Law-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On October 15, 2024, at 12: P.M. Licensing Program Analyst (LPA) made an unannounced case management visit to the above named facility. Purpose for the visit was to follow up and review TA's and TV's issued from the post licensing inspection conducted on August 2, 2024. LPA reviewed TA HSC 1565(f): HSC 1565(f)(2)(C) and found this to be completed HSC 1565(f)(2)(D) and found this to be completed CCR 80023(a) was found to be complete. CCR 84063(a)(10) was found to be complete. CCR 84063(a)(9) was found to be complete. CCR 84087(a)(4) was found to be complete. CCR 84088(j) was found to be complete. CCR 84072.2(a)(3) was found to be complete. Administrator will reprise the form with accommodating language for youth in care. Copy of the 809 was left with Administrator including appeal rights. No citations were issued. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On March 19, 2025 at 1: P,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met withTerrobin Phillips-Administrator. The facility currently has a provisional Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 12 to 17. The facility serves ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There is currently one (1) client in placement. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 3 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water in the facility premises. At 1: P.M.,LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked staff office. Sharps/knives are inaccessible and stored in a locked staff office cabinet. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked staff office cabinet . Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 115 degrees F. All sinks, showers and toilets are in working order. No more than one (1) children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. continued..... .....continued Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is the responsible and capable staff for communicating with emergency personnel in the facility. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster and fire drills are conducted monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Emergency Intervention Plan Facility does not use manual restraints. However, all staff (2) members are trained on emergency intervention procedures. Client Records LPA reviewed one (1) client record. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. Current client has been in the home for less than a month. Medical records have been requested and will be updated by Regional Center Staff LPA interviewed one (1) client in care. Continued..... ....continuation Staff Records LPA reviewed two (2) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. The administrator meets the required qualifications and/or experience. Documentation of the required education and experience will be sent to LPA. It was not observed at the time of the review. LPA verified at least 20 hours of annual training for Facility Manager. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (2) staff member. There were 2 citations assessed during this inspection one (1) technical advisory and three (3) technical violations. Exit interview conducted.

met_with: Terrobin Phillips-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 9, 2026 at 10: A,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met withTerrobin Phillips-Administrator. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 12 to 17. The facility serves ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There is currently one (1) client in placement. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 3 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water in the facility premises. At 10: A.M.,LPA conducted a walk-through of the entire facility. continued on page 2..... page 2....... Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked staff office. Sharps/knives are inaccessible and stored in a locked staff office cabinet. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked staff office cabinet . Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 115 degrees F. All sinks, showers and toilets are in working order. No more than one (1) child shares a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is the responsible and capable staff for communicating with emergency personnel in the facility. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster and fire drills are conducted monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Continued on page 3 page 3.... Emergency Intervention Plan Facility does not use manual restraints. However, all staff members are trained on emergency intervention procedures. Client Records There were no clients to interview. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. LPA requested Administrator to submit proof of psychotropic medicine approval from parent. Staff Records LPA reviewed three (3) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. The administrator meets the required qualifications and/or experience. LPA verified at least 20 hours of annual training for Facility Manager. LPA requested Administrator to submit proof of prudent parent training and signed staff duties/job description for one (1) out of three (3) staff. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (1) staff member. There were 3 citations assessed during this inspection. Exit interview conducted.


facility_name: A RAY OF SUNSHINE CHILDREN'S HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday February 3, Licensing Program Analysts (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Administrator Mesalina Lee-Gonzales. The facility has a census of five clients. Administrator Mesalina informed me that they are licensed for an Adult Residential Facility (ARF). They were licensed on 07/22/2021. Administrator made a copy of the license was given to LPA Ng. LPA Ng also received their Children's Residential license. An exit interview was conducted and a copy of this report was emailed to Administrator Mesalina .

met_with: Mesalina Lee-Gonzales


facility_name: ACHIEVER'S GROUP HOME

raw_content:
Investigation Findings:
13On 7/25/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Nelly Robillo, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on the report, the allegation pertains to client C1 (See LIC 811, dated 6/30/22), who sustained unexplained injuries while in care. While investigating, LPA Ng interviewed staff, case manager, and reviewed incident reports and Needs and Service Plans. LPA Valenzuela visited the facility on 6/30/22 and took pictures of (C1)'s arms. Upon review, there was two scrapes on (C1) left arm. The scrapes were ½ a centimeter in size and light brown and white in the middle. LPA Ng received an incident report dated 6/22/22, explains how C1 got the scrape, where it came from, and what immediate action was taken. Staff hugged C1 to shield them from C3, immediately separated them, treated the wound with an ice pack and antibiotics. LPA Ng found no additional cuts or bruises on client's arm. During confidential interviews from staff, (C1) got the scrapes from C3 which matches what was written in the incident report. After a review of C3's needs and service plan and talking to their case manager, C3 has a history of pinching behavior. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that minor sustained unexplained injuries while in care, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was sent to Nelly Robillo, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Nelly Robillo


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Investigation Findings:
13On 11/3/22 at 12: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Achiever's Group Home and spoke with Nelly Robillo, Administrator. The purpose of the inspection was to open the complaint and deliver the findings for the above complaint allegations. During investigation, interviews were conducted and documents were reviewed, and it was determined that the Facility incorrectly charged resident, Facility is mismanaging resident's P & I monies, and Facility is mismanaging resident's records. Based on LPA's interview with staff, clients, and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, Facility incorrectly charged resident, Facility is mismanaging resident's P & I monies, and Facility is mismanaging resident's records is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80026(h) Safeguards for Cash Resources, Personal Property and Valuables. At this time, one deficiency was given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Nelly Robillo, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: ACHIEVER'S GROUP HOMEFACILITY NUMBER: 015650113

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


summary: Facility Evaluation

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Narrative:
On 4/20/22 at 11: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced annual/required inspection to this location. LPA Ng came in at 11:45 and met with Administrator Nelly Robillo. Administrator informed LPA Ng that they closed the entrance gate due to the incidents of a client AWOLing (See LIC 809-C for more details).The facility is licensed for six residents, and currently in placement is 3 clients. LPA observed one client in care who is non-verbal, however appeared to be in good spirits. Client had a visitor which was her dad. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. LPA Ng toured the facility inside and out, and the facility consist of four bedrooms. Three bedrooms for clients and one for staff and all bedrooms are double occupancy and four bathrooms. Two bathrooms are located in master bedrooms which are located on both sides of the home, and two single bathrooms. The water temperature measured 105.4 degrees F. The facility is clean, safe and sanitary. The facility had sufficient perishable and nonperishable food supplies. The smoke detectors and fire extinguishers are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. ------Cont. On Lic 809c----- Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: Complaint procedures were not posted in the facility and was not accessible for staff and clients and their authorized representatives. LPA advises per CCR regulation, 84072.2(a)(3), complaint procedures must be posted in the facility within clear view of clients and their authorized representatives. LPA also gave a technical assistance regarding the entrance way. Upon arrival, LPA Ng called the facility five times due to no doorbell and locked entry way. There was no entry point or door bell to inform the facility that the LPA was here. LPA saw Administrator leaving and was able to flag Administrator Nelly down. Administrator let LPA come in to conduct the annual inspection. During Inspection, LPA Ng called the house phone and it rang. Administrator stated that they did not hear the phone. LPA let Administrator know that annual visits and all other CCL visits are unannouced and LPA's can show up at any time. Administrator informed LPA that they will install a doorbell at the gate to notify if a visitor/CCL is here. At this time, 1 deficiency and technical assistance were given. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Nelly Robillo, whose signature on this form confirms receipt.


summary: Facility Evaluation

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Narrative:
On 3/30/22 at 10: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced annual/required inspection to this location. The facility is licensed for six residents, and currently in placement is 3 clients. There were three staff present at the time of the inspection. All clients were at school at the time of the inspection. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. At 10: AM, LPA Ng toured the facility inside and out, and the facility consist of four bedrooms. Three bedrooms for clients and one for staff and all bedrooms are double occupancy and four bathrooms. Two bathrooms are located in master bedrooms which are located on both sides of the home, and two single bathrooms. All client bedrooms are currently single occupancy. The water temperature measured 107.5 degrees F. The facility is clean, safe and sanitary. The facility had sufficient perishable and nonperishable food supplies. Knives and chemicals are locked in a secure area. The smoke detectors and fire extinguishers are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. At 11: PM, LPA Ng observed the backyard with a wooden fence. There were two storage sheds on the side of the house. Both contained extra linens and decorations. There were no open bodies of water and no hazards. Their centralized AC unit was on the other side of the house and inaccessible to clients in care. All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. All medications were consistent with these records. One client is on psychotropic medication. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: ----cont on 809C---- During a review of the clients medication records, LPA Ng found that one client was taking psychotropic medication. Facility did not use a separate form for the psychotropic medication. Facility cited per CCR regulation, 84070(b)(13), under Children's Records. Please see 809D for more information. At this time, 1 deficiency was given. An exit interview was conducted, and a copy of this report was printed and given to Licensee/Administrator Nelly Robillo, whose signature on this form confirms receipt.


summary: Facility Evaluation

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Narrative:
On 05/31/2024 at 1: PM, Licensing Program Analyst (LPA) Jasmine Cardeno and Licensing Program Manager (LPM) Carolyn Flynn made an unannounced visit to Achiever's Group Home to conduct a required annual inspection. LPA Cardeno and LPM Flynn met with Facility Administrator, Nelly Robillo, who helped assist with the inspection. The Facility Achiever's Group Home has a current census of 3 clients and all clients are nonverbal. At the start of the inspection, the clients were at school and there were 4 staff present at the time of the inspection. Later, 2 clients came back home from school and greeted LPA and LPM and appeared happy, smiling at LPA and LPM. The CARE Inspection Tool was used to conduct the inspection. At the start of the inspection, LPA Cardeno and LPM Flynn conducted a walk-through of the facility, both inside the home and outside of the home. The facility is currently under construction for 1 client's bathroom. The client's bathroom is under construction to replace the flooring. LPA and LPM observed that there were construction materials and tools present on the facility grounds. When the clients were present on the facility grounds, the construction materials were removed and not made available for the clients. There are 3 bedrooms for clients and 4 bathrooms. There are 3 bathrooms for clients and each client has their own personal bathroom. All client bedrooms are single occupancy, and beds have clean linens. LPA Cardeno observed centrally stored medications maintained and locked secure in the closet located in the living room. The facility had sufficient perishable and nonperishable food supplies. The Facility Achiever's Group Home is maintained at 76 degrees Fahrenheit and the hot water temperature measures at 109.2 degrees Fahrenheit, which the temperatures are both within range. Sharps were locked in a secure cabinet under the sink of the kitchen. At 1: PM, LPA Cardeno observed that there was a sharp knife that was in a kitchen drawer and not locked away in a secure location. At this time, due to time constraints, LPA Cardeno was not able to conduct staff interviews and do further file review including the client files and staff files during this visit. LPA Cardeno discussed the following with Facility Administrator, Nelly Robillo, and issued Technical Violations: LPA observed the chemical cleaning supplies that were stored were not locked away as the garage door was open. Usually, the garage door is closed and the door to the garage storage area is locked and the cleaning supplies are locked in the location. LPA observed that there was a sharp in a drawer that was unlocked. The Facility Administrator locked away the sharp right away in the secure cabinet and explained that the knife was used during the construction. An exit interview was conducted, and a copy of this report was given to Facility Administrator, Nelly Robillo, whose signature on this form confirms the receipt. LPA Cardeno will continue this Annual Inspection at a future date.

met_with: Nelly Robillo, Facility Administrator


summary: Facility Evaluation

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Narrative:
On 07/24/2024 at 10: AM, Licensing Program Analyst (LPA) Jasmine Cardeno made an unannounced visit to conduct a continuation of the Annual Inspection for Achiever's Group Home and met with Facility Administrator, Nelly Robillo. Achiever's Group Home currently has a census of 3 clients. No client interviews were conducted, as the clients are nonverbal. At the time of the visit, 5 staff were present and 2 staff interviews were conducted. At 11: AM, LPA did a walk-through of the facility, facilitated by Nelly Robillo. LPA observed that the client bedroom that was previously under construction for the bathroom, is no longer under construction and the bathroom has been fully repaired and remodeled. Achiever's Group Home is currently not going under construction and the construction has been finished. All of the walkways are free of obstructions. LPA toured the kitchen and observed sufficient supply of food including perishable and non-perishables and observed the weekly food menu items to be posted. LPA observed centrally stored medications maintained and locked secure in the closet located in the living room area. The Facility Achiever's Group Home is maintained at 72 degrees Fahrenheit and the temperature is within range. At 11: AM, LPA checked the previous two technical violations that were cited from the visit for the initial Annual inspection. LPA observed that the cleaning supplies and materials were stored in a secure location that is not accessible to the clients and all sharps were kept locked in the secure cabinet under the sink of the kitchen. At 11: AM, LPA reviewed 3 client records and 7 staff records. LPA observed the clients records to be complete and up to date including Psychotropic Medication Administration Records. LPA observed the staff records including the Administrator's file to be complete including the CPR/First Aid Certifications, Background Check Clearances, Trainings, and other documents. At 1: PM, LPA interviewed 2 staff. An exit interview was conducted, and a copy of this report was given to the Facility Administrator, Nelly Robillo, whose signature on this form confirms the receipt


summary: Facility Evaluation

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Narrative:
On April 23, 2025 at 7:30am, Licensing Program Analyst (LPA) Monica Pavia made an unannounced inspection to Achiever's Group Home to conduct a required annual inspection. LPA Pavia met with Facility Administrator, Nelly Robillo, who helped assist with the inspection. Achiever's Group Home has a current census of 3 clients and all clients are nonverbal. The clients were at school during LPA inspection. There were 3 staff present at the start of LPA inspection. This annual inspection (including review of staff and clients files), will be reviewed at a later date. Licensee paid annual fees due, via online with PIN provided, during LPA inspection. Please update the following facility forms and submit to CCL by 5/14/25: 1. LIC308 2. LIC309 3. LIC500 4. Lic610c


summary: Facility Evaluation - 1 deficiency

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Narrative:
On May 13, 2025 at 7:30am, Licensing Program Analyst (LPA) Monica Pavia made an unannounced inspection to Achiever's Group Home to complete a required annual inspection. LPA Pavia met with Facility Administrator, Nelly Robillo, who helped assist with the inspection. Achiever's Group Home has a current census of 3 clients and all clients are nonverbal. The clients were at school during LPA inspection. There were 3 staff present at the start of LPA inspection. LPA Pavia reviewed 3 client files and 3 staff files, on above date. The following Title 22 deficiencies, Type A, were cited on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, sections 84088.3 and 80087(c). The following Title 22 deficiencies, Type B, were cited on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, sections 80087(g) and 84068.3(a). The following Technical Violation (TV) was written and reviewed on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, section 84070(b)(16). The following Technical Advisories (TAs) were written and reviewed on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, sections 84072(a), 80088(f)(1) and 84064(e)(1). Copies of all reports were left with Administrator in addition to Licensee Appeals Rights explained and a copy given to Administrator.

Deficiencies:
84068.3(a): Modifications to Needs and Services Plan

(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


summary: Facility Evaluation

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Narrative:
On 04/15/2026 at 12:00 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Nelly Robillo, Administrator. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. LPA Rodriguez used the CARE Inspection Tool. The facility currently has a census of two clients. LPA Rodriguez reviewed six (6) staff files, two (2) client files, LPA Rodriguez also reviewed the emergency disaster plan binder. LPA Rodriguez conducted one (1) confidential staff interview. During the physical plant inspection, LPA Rodriguez toured the facility inside and out. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and full-sized beds. Each bedroom has drawers for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. Extra linens are located in a closet in the hallway. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. No bodies of water on the premises. All walkways were free from debris or hazards. LPA also toured the backyard. There was one Technical Violation (TV) issued during the inspection. A copy of TV will be given to Nelly Robillo, Administrator. (continue on LIC 809-C) The required Annual Inspection is complete. An exit interview was conducted at 2:55 p.m., and a copy of this report was given to Administrator Nelly Robillo, whose signature on this form confirms receipt.

met_with: Nelly Robillo, Admimistrator


facility_name: ADOLESCENT GROWTH INC.

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Narrative:
Confidential statements obtained could not corroborate the allegation. The facility client who made the initial disclosure later changed their account during the investigation denying the allegation. Other confidential statements obtained from facility clients did not provide any corroborating evidence to support the allegation. Facility staff also denied the allegation. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On December 15, 2022 at 4: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated by Community Care Licensing, Investigations Branch, Investigator Laura Garcia and LPA Rarela. During the course of the investigation, Investigator Garcia interviewed a former facility client on 10/13/22, facility staff on 10/13/22 and 10/18/22; LPA interviewed facility clients on 10/4/22, and facility staff on 10/4/22 (see Confidential Names Form dated December 15, 2022). Investigator Garcia also reviewed documents including CPS reports, facility records and incident reports. It was alleged that an unknown facility staff provided a facility client with illicit drugs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela 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 32-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, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Adolescent Growth INC.FACILITY NUMBER: VISIT DATE: 12/15/2022

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

met_with: Dr. Joy Lewis, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Adolescent Growth, Inc. on March 17, 2022 at 10:20am for the purposes of conducting a Required Year inspection. LPA met with Dr. Joilyn Lewis, President/CEO and John Lewis, COO, and discussed the purpose of today's visit. The license issued by Community Care Licensing (CCL) allows the licensee to serve six ambulatory clients ages 12-17 years old. The facility is located in a residential neighborhood and has three bedrooms, three bathrooms, kitchen, living room, and dining area. LPA and the licensee toured the facility and discussed the inspection in detail. Currently, there are no clients in placement at the facility. The facility has no direct care staff as of this date but is in the process of hiring new staff. LPA observed three bathrooms to be in good repair and working order. The three bedrooms contained two twin beds in each bedroom as well as ample closet space. LPA observed adequate seating in the dining area and the living room. The smoke alarms were operable throughout the facility. There is also a classroom area inside the facility for the clients to use. LPA observed several desks and chairs in the classroom area that were arranged in a classroom style setting. There were books, board games, and arts and crafts supplies inside the classroom. . The facility does not have any clients in placement at this time nor direct care staff; therefore, no client or direct care staff files were available to review. The President/CEO stated that there were no guns or weapons on the premises. Licensee will scan LPA an updated LIC500 (Personnel Report) and a copy of their most recent Board of Director's meeting minutes. LPA found no Title 22 deficiencies on this date. Exit interview done

met_with: Dr. Joilyn Lewis,President/CEO and John Lewis, COO


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Adolescent Growth, Inc. on February 02, 2024 at 11:00am for the purposes of conducting a Random Annual inspection. LPA met with Dr. Joilyn Lewis, President/CEO (P/CEO) and John Lewis, COO, and discussed the purpose of today's visit. The license issued by Community Care Licensing (CCL) allows the licensee to serve six ambulatory clients ages 12-17 years old. The facility is located in a residential neighborhood and has three bedrooms, three bathrooms, a dining area, living room, and a kitchen. LPA and the P/CEO toured the facility and discussed the inspection in detail. Currently, there are no clients in placement at the facility. Also, the facility has no direct care staff employed at the facility as of this date. Therefore, no client or direct care staff files were available to review. LPA observed three bathrooms to be in good repair and working order. The three bedrooms contained twin beds in each bedroom and ample closet space. LPA observed adequate seating in the dining area and the living room. Smoke alarms and fully charged fire extinguishers were available at the facility as well. The P/CEO stated that there were no guns or weapons on the premises. Licensee provided LPA an updated LIC500 (Personnel Report) and a copy of their most recent Board of Director's meeting minutes. LPA found no Title 22 deficiencies on this date. Exit interview done.

met_with: Dr. Joilyn Lewis, President/CEO and John Lewis, COO