summary: Facility Evaluation

raw_content:
Narrative:
On April 16, 2026, at 9:10 am Licensing Program Analyst's (LPA's) Cynthia Robinson and Jessica Peete arrived to The Real Life Center, Group Home (GH) to conduct an unannounced Annual Random inspection. LPA's were greeted and granted access by the Director, Roy Bennett. The group home was observed to be non-operational, with no clients in care or working telephone lines. Director Bennett stated there have been no clients in care since 2011. The Group home does not employ any direct care staff, administrators, facility managers, therapists, or social work staff. The licensee is currently converting from a group home to a Short-Term Residential Therapeutic Program (STRTP). Per the Director's statement, there are no plans to accept clients until STRTP licensure is completed. The licensee was advised that if the plan changes, the facility should contact Community Care Licensing prior to placing children to schedule a follow-up visit. At 9: AM, assisted by the Director, LPA's Robinson and Peete completed an inspection of the physical plant. The inspection of the first floor included the living room, dining area, day room, staff office, kitchen, laundry room, storage closet, two client bathrooms, and three client bedrooms. The temperature in the downstairs bathroom tested at 106F. LPA's observed that the dayroom, and the living room was furnished with couches and tables in good repair. The day room was being used as storage, as LPA's observed boxes, various non-operable office equipment, and exposed wiring. The laundry room also included storage, operable washer and dryer. The kitchen, also used for storage, had a working gas stove and running water. Appliances on the counter were not plugged in. The client's bedrooms are arranged so that no more than two clients are in any room. Each client room has the appropriate linens, and the mattresses, pillows, and comforters are in good repair. Additionally, there is adequate drawer and closet space for each client's belongings. Client bedroom #3, as identified by the Director, has a crack in the ceiling, which the Director stated is being repaired. (Continued on LIC 809C...) The second floor of the group home consists of one staff conference room, a counseling office, two staff offices, one staff bathroom, a pantry/storage, a deep freezer for excess food storage, and a counseling room. LPA's observed that the staff offices and conference room were equipped with desks and chairs, but no working office equipment. There was wall damage in the upstairs hallway above the window and the adjacent wall; the Director stated a work order had been called in. Per the Director's statement, the second floor of the facility will not be made accessible to clients without staff supervision. LPA's observed that all cleaners and chemicals are stored in the first-floor storage closet, which can be locked to make the contents inaccessible to clients. Additionally, LPA's observed the following postings: facility license, grievance procedures, personal rights, and Ombudsman poster. Age-appropriate toys, games, and books were observed for the client's recreation time. No medications were on the premises at the time of the visit. The Director stated that the client's medications will be made inaccessible and stored in a locked cabinet in the downstairs staff office. Additionally, as there are no clients in care and the facility is non-operational, LPA's did not observe a minimum 7-day non-perishable and a 2-day perishable food supply. The facility has a working security alarm and fire panel located in the front hallway. LPA's observed and tested the smoke detectors located in two of the three clients' bedrooms; the downstairs and upstairs hallways were working. LPA's did not observe carbon monoxide detectors in the facility. Per the Director's statement, they will be ordered and installed in various locations inside the facility. There are two fire extinguishers downstairs: one in the kitchen and the other outside the dining area, and third one upstairs in the entrance hall. The fire extinguishers are properly serviced and charged, with the inspection tag indicating the next service is due by May 9, 2026. The facilities outside the grounds (front yard and backyard) were also inspected and found to be clean, well maintained, and free of observable hazards. However, LPA's observed one non-operable company vehicle parked on the basketball court, which the Director stated is being repaired and will be removed from the grounds. LPA's also observed that the backyard fences are padlocked with a chain. Per the Director's statement, the locks and chains will be removed when the facility is in operation. LPA's further observed that there were no bodies of water on the facility grounds and that there was adequate indoor and outdoor activity space; all exits and walkways in and outside the facility were free of obstruction. Per the Director's statements, there are no guns or weapons on facility grounds. Per Director's statement, the facility conducts a monthly walk through to ensure grounds are maintained. Based on the facility inspection and file reviews conducted this date, no deficiencies were found at this time. An exit interview was completed; a copy of this report was reviewed and given to the Facility Director.

met_with: Roy Bennet, Director


state: CA

facility_name: REAMER RESIDENCE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 7/25/22 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Irene Lakandula, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During Investigation, confidential interviews were conducted, and incident reports reveal that C1 (Please refer to LIC811) had a rash near his genital area. Maxim staff who is employed as a third party at the facility, first noticed the rash and notified C1's mom and the S1. C1's mom notified S1 that she will be scheduling a doctor's appointment and asked for the facilities availability. S1 suggested that 6/24/22 would be a good day to take C1 for the appointment. S1 did not hear back until 6/28/22 when C1's mom called S1 and explained that he had a conversation with the Doctor regarding the injury near the genital rash and sent a photo to the Doctor. The Doctor advised C1's mom to put Vaseline. C1's mom said that Vaseline might irritate C1 more. On that same day, a nurse consultant came to the facility to assess the rash. The nurse consultant instructed staff to keep doing body checks and to put Vaseline on the rash. C1's mom told S1 that there is no need for the appointment and to notify her if it happens again so C1's mom can decide if an appointment should be made. During confidential interviews, all parties deny seeing all four clients in the bathroom together. The facility allows clients to independently walk around in the facility. If clients are fighting or get too close, staff will redirect them immediately. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff did not seek client medical attention and facility staff are not adequately supervising clients, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was sent to Irene Lakandula, 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:

report_type: Complaint Investigation

met_with: Irene Lakandula

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On Friday 05/20/2022 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced visit to conduct an annual required inspection. LPA met with Irene Lakandula, Administrator. The facility has a census of 4 clients. All clients were at school. One client came home at 12:20 pm. Client was non-verbal but appeared to be in good spirits. Safety precautions were taken, including temperature checking, hand hygiene, and mask-wearing. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. Bedrooms are single-occupancy, and beds have clean linens and mattress pads. There is one staff room that is double-occupancy. There is enough storage for residents' personal belongings. There are three bathrooms. Sharps were locked away and located in the kitchen. Chemical and poisons were located and in the laundry room away from clients. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was maintained at a comfortable temperature within permitted range. Water temperature measured at 110.5 which is in the permitted range. LPA conducted 2 confidential staff interviews. The backyard is surrounded by a wooden fence. There is a small shed in the backyard that is used for storage and a break room. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. Facility has comfortable furnishings, accommodations, and ample lighting. All 4 client records complete with all of the required documentation. Each client has their own separate binder of all required documents. -----Cont. on 809-C----- 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. LPA Ng reviewed 5 staff records. Resident and staff records were observed to be complete and the facility in compliance. At this time, no deficiencies were cited. An exit interview was conducted, and a copy of this report was emailed to Administrator Irene Lakandulas, whose signature on this form confirms receipt.

report_type: Facility Evaluation

visit_type: Annual


facility_name: REDSTONE HOUSE

raw_content:
Narrative:
The complaint alleged that staff engaged in a physical altercation with minor and that staff did not allow minor to have a beverage. Confidential interviews reveal that minor woke up in the late night/early morning hours and wanted to adjust the thermostat at the facility. Minor also took juice from the kitchen. Minor insist that staff grabbed minor by the wrist after minor attempted to adjust the thermostat. Minor reacted by pushing staff out of minor's way. Minor stated that there is no house rule about not having juice at night. Staff denied the allegations. Staff reminded minor that no one is allowed to adjust the thermostat. Minor adjusted the thermostat anyway and became verbally and physically aggressive to staff. Staff redirected minor and denied engaging in a physical altercation. Staff denied causing any injury to minor. Minor then went to the kitchen, took some juice and went back to the bedroom. Staff reminded minor that juice is not allowed that late but offered minor water instead, which minor declined. Other parties interviewed described minor as verbally and physically aggressive when upset and is known to make false allegations and verbal threats towards staff. Minor had made repeated inappropriate comments towards the identified staff in the past. The facility moved identified staff to another facility to prevent any further incidents between staff and minor. There was no witness to the allegations; the staff was the only one working the graveyard shift when the incident occurred, and one other client was asleep. There was no corroborating evidence found to support the allegations. Based on the information gathered, although the allegations may have happened or are valid, the preponderance of evidence to prove the allegations was not met, therefore the allegations are unsubstantiated. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. Appeal rights provided and explained. There was no deficiency citation issued.

Investigation Findings:
13On July 7, 2022 at 10: AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the foster family agency to deliver the finding of the allegation. LPA met with the facility representative named above. LPA investigated the allegations by conducting confidential interviews with the identified client and three facility staff. LPA was unable to obtain a statement from another client in placement; the client is non-verbal and did not witness the incident. Records were reviewed such as, but not limited to, the placement agency report, Special Incident Report, Behavior Assessment Reports and Individualized Behavior Support Plans. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto 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: REDSTONE HOUSEFACILITY NUMBER: VISIT DATE: 07/07/2022

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

met_with: Anamaria Ramos, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 23, 2021 at about 10:30AM, Licensing Program Analyst (LPA) Gilbert Gutierrez arrived at the facility and met Facility Manager (FM) Carlo Garduno. The inspection was an annual required inspection. The administrator arrived at the facility after a while. This facility is a one- story home with 3 bedrooms and 2 bathrooms and detached garage. Currently there are 3 clients placed in this home. The facility is operating within its approved capacity. At around 10:45AM LPA and FM toured the home. LPA observed the following: the posted license, emergency disaster plan, client's Personal Rights, staff schedule and menu. There was sufficient perishable foods enough for two days and sufficient non-perishable foods for clients' consumption for a week. The medications were observed locked in the cabinet in the kitchen. The knives were locked in a drawer in the kitchen. The first aid kit was complete. Each client's bedroom has a twin bed with clean sheets and linens. Each bedroom has adequate drawers and closet space for the client's clothing. There were extra linens, extra towels and hygiene supplies in the hallway cabinet. The smoke/carbon monoxide detectors were tested and working. There is a fire extinguisher located in the kitchen. The water temperature was 114 degrees within the temperature allowed under Title Regulations. There were extra perishable food items in a refrigerator, emergency supplies and extra cleaning supplies in the garage. All passageways were unobstructed. There was no body of water in the premises. At 11:40AM, LPA started reviewing three clients and seven staff files. Also reviewed were the emergency disaster plan and monthly fire drills and client medication logs. A review of staff records on June 23, 2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. No deficiency citations issued during this visit. The facility operates within license capacity and limitations. A copy of this report was provided to the facility administrator at the conclusion of the inspection.

met_with: Wanda Magee


summary: Facility Evaluation

raw_content:
Narrative:
On February 2, 2022, at 9:00AM, Humberto Flores, Licensing Program Analyst (LPA), conducted an unannounced Case Management Inspection at Redstone House Group Home (GH) and met with Facility Manager (FM) Ana Maria Ramos. The purpose of the inspection was to gather information and deliver the findings for the incident reported via Special Incident Report (SIR). On 2/25/20, the GH reported that Child Ref #1 (C1) (see Confidential Names form LIC811 dated 2/02/22) left the facility unattended, while waiting for the bus to arrive. LPA Flores investigated the incident. A review of C1's file was conducted and copies were made. The information revealed that on 2/24/2020, C1 left the facility while waiting for the bus. Staff Andrew Dominguez (AD) and Xochilt Zamora (XZ) were on duty. According to statements documented by the GH, AD and XZ were cleaning the kitchen and they thought that other staff (name undisclosed) would place children on the bus. Once AD and XZ realized that C1 was unaccounted for they went outside to look for him. C1 was found in a neighbor's front yard playing with dirt. cont.# The GH will be issue an Advisory Notes / Technical Violation. No further inspection is needed at this time. A copy of this report and LIC811 was provided to the GH representative. Exit interview conducted.

visit_type: Case Management

met_with: Ana Maria Ramos., Facility Manager (FM)


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Gilbert Gutierrez and Pamela Silva on April 12, 2022. During the inspection, LPAs met Anamaria Ramos, Facility Manager (FM) who provided the tour of the facility inside and out. At the time of the inspection, no client present in the facility. LPAs conducted a tour of the facility at 9: AM. The facility is clean, safe, sanitary and in good repair. All medications are centrally stored, locked and accessible only to employees responsible for stored medications. There is adequate staffing in the facility to provide care and supervision for the clients per facility's Plan of Operation/Program Statement. Out two clients, only one is dual placement. LPAs reviewed one client file at 9:25am. LPAs interviewed a total of three staff at 10:00 am and reviewed three records at 11:00am. No deficiency citations issued at the time of the inspection. However, one technical violation was issued (see LIC TV). An exit interview was conducted and copy of this report, LIC TV and LIC 811 were provided to Administrator, Wanda Magee.

met_with: Anamarie Ramos, Wanda Magee


summary: Facility Evaluation

raw_content:
Narrative:
On October 24, 2022, at 8:50AM, Humberto Flores, Licensing Program Analyst conducted an unannounced Annual Inspection to the Redstone House Group Home (GH) and met with Anamaria Ramos. LPA Flores stated the purpose of the inspection to the GH representative. LPA Flores conducted a tour of the facility along with Anamaria Ramos. It was observed that the facility was clean, safe, sanitary and in good repair. The passageways and ramps are unobstructed. The disinfectants and cleaning solutions are inaccessible to the children. There are not swimming pools or similar bodies of water in the facility. The children in care are always supervised and protected. The GH representative stated that there are not firearms in the facility. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F) and the hot water temperature was at 107F. The GH has non-perishable foods for one week and perishable foods for two days and nutritious snacks are provided between meals. Medications are locked and accessible only to employees supervising stored medications. A medication count was conducted, and it was correct. The fire alarms and carbon monoxide detectors were checked and are operating. cont.# The GH has not sent to the Department the biannual review of manual restraints for the last 2 periods, July- December of 2021, and January-June 2022. The GH representative stated that there has been no restraint. No citation was issued. A copy of this report, LIC811s and LIC912 was provided to the facility representative. Exit interview conducted. cont.# Children Records: LPA reviewed 4 children's files. The files contain record of client's admission agreement, medical assessment, consent forms, weight record, emergency information, appraisal and needs and services plan, immunization record, tuberculosis test, centrally stored medication record, safeguards for property/valuables, personal rights form and cash resource information. Staff Records: A total of 4 employee files was reviewed. The files contain the following documentation: first aid certificate, Child Abuse Index Checks/Department of Justice (DOJ)/Federal Bureau of Investigation (FBI) criminal record clearances, education verification, personnel record, health screening, criminal record statement, employee rights and tuberculosis test. Personnel policies, job descriptions and training verification are included in the employee's files. Administration/Accountability: The minutes of board of directors' meetings were available to the licensing agency to inspect, audit, and copy upon demand. The Emergency Evacuation plan and physical plant sketches are posted. The Emergency Disaster Plan, LIC 610C was posted. Personal rights listing is posted. Facility License was posted in a prominent place.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Redstone House on August 24, 2023 at 12:20pm for the purposes of an unannounced Required Annual inspection. LPA met with Andrea Velazquez, Facility Manager and Helen Navarro, Administrator Trainee, and conducted a tour of the facility. The facility is licensed to serve four (4) developmentally disabled clients ages 9-17 years old, ambulatory and non-ambulatory. The facility is a group home comprised of three bedrooms and two bathrooms. It is located in a residential neighborhood and has a living room, garage, dining area, and a kitchen. At the present time, there are four clients in placement at the facility. LPA observed a fully stocked pantry as well as fully stocked refrigerators in the kitchen and the garage, respectively. Chemicals and cleaning supplies are kept locked in a cabinet beneath the kitchen sink. Medications are also kept locked in a cabinet in the kitchen. The kitchen was observed to be clean and well stocked with several food items (perishable and nonperishable). Sharp knives are kept locked in a cabinet in the kitchen. LPA observed two bathrooms to be in good repair and working order. LPA also observed a fully stocked linen closet in the hallway. Licensee has personal hygiene items for each client. All three bedrooms contained either a full bed or twin beds, dressers, and closet space. LPA observed a fully charged fire extinguisher in the kitchen area. The First Aid Kit was fully stocked with scissors, tweezers, bandages, band-aids, and a thermometer. LPA observed the following items posted on a bulletin board in the kitchen: Rights of Individuals with Developmental Disabilities Grievances/Complaint Policy and Procedures Hydration Policy Emergency Disaster Plan Smoke alarms were operable throughout the facility. There is adequate seating in the dining area and the living room. The outdoor areas were observed to be free of debris and hazards. LPA visited the garage and observed survival packs for each client as well as extra cleaning supplies. LPA did not observe any pools or other bodies of water on the premises. The Administrator Trainee stated that there were not any guns or weapons at the facility. LPA randomly reviewed four staff files and all four client files and found the reviewed files to be in order. The last fire drill was held on August 10, 2023 at 5:00p.m. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a client roster. LPA also obtained a copy of the minutes from the Board of Director's meetings that were held on March 30, 2023, April 27, 2023, and May 25, 2023, respectively. LPA observed three nonverbal clients at the facility during the inspection. The clients all appeared neat and well groomed. The other client residing at the facility was in school during the inspection. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Pamela Silva and Juliet Robles on January 29, 2024 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Ana Maria Ramos, Administrator, and inspected the facility inside and out. LPAs reviewed one (1) of child's records and three (3) of staff personnel files on site at the facility. LPAs reviewed one (1) of child's psychotropic medications and medication records. LPAs interviewed two (2) of staff on site to discuss the facility's policies and procedures of operation. LPAs interviewed 0 of children currently prescribed psychotropic medication due to child being non-verbal. LPAs provided a copy of this licensing report to Ana Maria Ramos, Administrator. No deficiencies are being cited at this time. LPAs conducted exit interview with the Administrator.

met_with: Ana Maria Ramos


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Redstone House on June 20, 2024 at 1:38pm for the purposes of an unannounced Required Annual inspection. LPA met with Vivian Orozco, Direct Care Staff (DCS) and Anamaria Ramos, Administrator, and discussed the purpose of today's inspection. LPA and the DCS conducted a tour of the facility. The facility is licensed to serve four (4) developmentally disabled clients who may be ambulatory or non-ambulatory. The facility is located in a residential neighborhood and has three bedrooms, two bathrooms, living room, garage, dining area, and a kitchen. Currently, there are four clients in placement at the facility. LPA observed a fully stocked pantry as well as a fully stocked refrigerator in the kitchen. Medications are kept locked in a cabinet in the kitchen. The kitchen was observed to be clean and well stocked with several food items (perishable and nonperishable). Sharp knives, chemicals, and cleaning supplies are kept locked in areas inaccessible to clients. LPA observed two bathrooms to be in good repair and working order. P The First Aid Kit was fully stocked with scissors, tweezers, bandages, band-aids, and a thermometer. Smoke alarms were operable in each bedroom. There is adequate seating in the dining area and the living room. The outdoor areas were observed to be free of debris and hazards. LPA did not observe any pools or other bodies of water on the premises. LPA observed all three bedrooms with a bed, dresser, and closet space Files were reviewed and all were found to be in order. The last fire drill was held on February 10, 2024 at 8:00p.m. The last earthquake drill was held on June 10, 2024 at 9:00am. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a client roster. LPA also obtained a copy of the minutes from the Board of Director's meetings that were held on March 28, 2024 and April 25, 2024. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted

met_with: Vivian Orozco, Direct Support Staff and Anamaria Ramos, Administratorl


facility_name: REM CALIFORNIA, LLC - TOPAZ

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The investigation revealed on Friday, February 3, 2023, school personnel notified facility staff of Client #1's (C1) illness symptoms and advised that C1 be picked up to be sent home. Statements revealed that although facility staff members were aware C1 was ill since February 3, 2023, when notified by the school, the facility staff neither obtained medical attention for C1 nor kept C1 home from school on the following Monday, February 6, 2023. On Monday February 6, 2023, C1 was sent to school and observed appearing in worse condition than the prior Friday. School personnel again called the facility to pick up C1 due to illness. On the morning of February 7, 2023, C1 was discovered by staff, laying on the floor in their room. C1 was transported to the hospital by ambulance from the facility with confusion and shortness of breath. C1 was placed into intensive care and intubated in critical health. C1's condition continued to de-escalate over time and on March 1, 2023, C1 succumbed to death due to medical complications. During the week proceeding C1's hospitalization, C1 had been observed exhibiting symptoms of not feeling well while at school. Documentary evidence determined that C1 died from illnesses that were contracted while in the care of the facility. Based on confidential interviews, review of documentary evidence and medical reports, the preponderance of evidence standard has been met. The Department has determined substantiated findings that staff did not provide medical attention in a timely manner contributed to C1's death. This poses an immediate health, safety, and personal rights risk of harm to children placed in care. The facility is issued a citation in accordance with the California Department of Regulations, Title Chapter 5, Division 6, 84078(b) Responsibility for Providing Care and Supervision and 84064(f)(4) Administrator Qualifications. The Department has concluded an analysis and determined that an enhanced civil penalty of $7,500 is warranted under Health and Safety Code 1548(e). The Department has issued an immediate Civil Penalty Assessment of $7,500. A copy of this report, Appeal Rights, and form UC 421-D(CRP) Civil Penalty Assessment- Death/ Serious Bodily Injury/ Physical Abuse was provided to Facility Representative during this visit. Continued on page LIC9099-D)

met_with: Eva Valentin, Area Director

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 02/12/24, at 11:35 am, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the findings. LPA spoke with Colleen Nawrot and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, documents were reviewed and confidential interviews were conducted with the Facility Administrator (FA), facility staff, client, and relevant contacts. During the confidential interviews, the validity of the allegation could not be determined. Parties interviewed could not determine the cause of the injuries. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was emailed to FA. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez 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: Facility Adminstrator - Collen Nawrot


summary: Facility Evaluation

raw_content:
Narrative:
On 1/26/2022 at 8:30am Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management Post-Licensing Inspection at REM California, LLC-Topaz v. LPA met with Gaby Zaragoza staff #1 (S1) who granted access to the facility and toured the home in and out. In the middle of the inspection Danny Rabara Facility Administrator (FA) arrived at the facility and continued the tour due to that S1 had to leave. This is a three-bedroom, two-bathroom, single story family residence that includes a living room, dining area, office area, kitchen, laundry area and an attached garage. LPA toured the entire facility and observed the following: Bedroom #1 is occupied by one male client, it has one twin size bed, adequate closet space, there's no clothes in the client's room due to that client #3 (C3) rips all the clothes. FA stated that he will get the documentation from the Regional Center regarding the issue of not having the client's clothes in C3's room. Bedroom #2 is occupied by one male client, it has one queen size bed, adequate closet and drawer space. Bedroom #3 is occupied by two male clients, it has one twin size bed, and one full size bed adequate walking closet and drawer space bathroom was clean at the time of the inspection. [See LIC Confidential Names List form (LIC811), dated 01/26/2022, for names] LPA observed non-perishable foods for one week and perishable food for two days. Facility is clean and sanitary. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Menu is posted in the kitchen. Outdoor space is free of debris and hazard. Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knives are inaccessible to the clients. Continue on LIC809-C Meds are locked and accessible only to employees supervising stored medications. Home has working smoke alarms, carbon monoxide detectors and working fire extinguishers at the time of this inspection. The home is equipped with two (2) bathrooms were operable at time of inspection. The facility has a working telephone/landline. There is no bodies of water on the premises. Kitchen/Dining area: There was one (1) refrigerator, microwave, one (1) stove one (1) with five (5) burners, all operable at the time of the inspection. There was a large dining table with four (4) chairs. A trash can with a lid on was observed in the kitchen area. Laundry Room: There was a laundry room in the garage equipped with a sink, one (1) washer and one (1) dryer during the time of the inspection. Per California Code of Regulations, Title Regulations, Division 6, chapters 5, no deficiencies are cited at this time Exit interview was conducted and a copy of this report will be emailed to the facility Administrator due to technical difficulties with LPA's printer.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 5/26/2022 at 9:00am Licensing Program Analyst (LPA) Enrique Hernandez conducted an annual/Required inspection at REM California, LLC-Topaz v. LPA met with Danny Rabara Facility Administrator and Colleen Nawrot Program Director who granted access to the facility and toured the home in and out. This is a three-bedroom, two-bathroom, single story family residence that includes a living room, dining area, office area, kitchen, laundry area and an attached garage. LPA toured the entire facility and observed the following: Bedroom #1 is occupied by one male client, it has one twin size bed, adequate closet space, there's no clothes in the client's room due to that client #1 (C1) rips all the clothes. FA stated that he will get the documentation from the Regional Center regarding not having the client's clothes in C1's room. Bedroom #2 is occupied by one male client, it has one queen size bed, adequate closet and drawer space. Bedroom #3 is occupied by two male clients, it has one twin size bed, and one full size bed adequate walking closet and drawer space bathroom was clean at the time of the inspection. [See LIC Confidential Names List form (LIC811), dated 05/26/2022, for names] Kitchen/Dining area: There was one (1) refrigerator, microwave, one (1) stove one (1) with five (5) burners, all operable at the time of the inspection. There was a large dining table with four (4) chairs. A trash can with a lid on was observed in the kitchen area. LPA observed four (4) spoiled bananas and a lemon cut in half seating in the kitchen counter. Laundry Room: There was a laundry room in the garage equipped with a sink, one (1) washer and one (1) dryer during the time of the inspection. Continue on LIC809-C Living Room: The area has a tv mounted on the wall. LPA observed worn sofas. FA stated that they will place an order today with the executive assistant. Meds are locked and accessible only to employees supervising stored medications. Home has working smoke alarms, carbon monoxide detectors and working fire extinguishers at the time of this inspection. The home is equipped with two (2) bathrooms were operable at time of inspection. The facility has a working telephone/landline. There is no bodies of water on the premises. LPA observed non-perishable foods for one week and perishable food for two days. Facility is clean and sanitary. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Menu is posted in the kitchen. Outdoor space is free of debris and hazard. Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knives are inaccessible to the clients. The facility has a Chrysler Pacifica 2020 to transport clients. Current automobile insurance is with National Union Insurance Company. Due to time constraints, LPA will return to review the client/staff files in order to complete the Per California Code of Regulations, Title Regulations, Division 6, chapters 5, no deficiencies are cited at this time Exit interview was conducted and a copy of this report will be emailed to the facility Administrator due to technical difficulties with LPA's printer.

met_with: Facility Administrator


summary: Facility Evaluation

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Narrative:
On 3/3/23, at 11:55am Licensing Program Analyst (LPA) Nancy O'Connell conducted a Case Management - Incident inspection at the above-listed facility, and met with Colleen Narwot Facility Administrator (FA), in response to a Special Incident Report that reported to Community Care Licensing (CCL) on 3/2/23. The incident, which occurred on 3/1/23, involved client (C1), who passed away on 3/1/23 at a local hospital due to medical reasons. [See LIC Confidential Names List form (LIC811), dated 3/3/23, for names]. During the time of the inspection, LPA O'Connell conducted a walk through of the facility with FA and S1 and observed the kitchen to have locked knives, cleaning supplies,and there was appropriate signage posted. LPA inspected medical records, logs, and medication prescripts for all residents, and found them to be centrally stored, with accurate information recorded. LPA inspected all bedrooms, common areas, bathrooms, backyard space, and found the facility to be clean, sanitary and in good condition. LPA interviewed the Facility Administrator (FA), and the Lead Direct Service staff (S1) to obtain information related to the events leading up to the special incident event that occurred on 3/1/23. LPA requested the following documents: LIC500, client roster, shift reports for S2 and S3 on night of 2/6/23, C1's medication list, emergency procedures plan, S4's 1:1 staffing notes for 2/6/23, shift notes from S1 for 2/6/23, and NOC logs for 2/26/23, and the contact information for the primary care physician for C1. Continued on LIC809C LPA requested a copy of C1's death certificate, as well as a completed Death Report (LIC624A form), as soon as it becomes available. LPA requested that documents be submitted to the Culver City Children's Residential Regional Office, as soon as possible. At this time, further investigation is required in order to the determine whether any violation had occurred. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left with the Facility Administrator (FA).

met_with: Colleen Narwot, Facility Administrator (FA)


summary: Facility Evaluation

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Narrative:
On 7/13/23, at 11:00am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an annual/Required inspection at REM California, LLC-Topaz. LPA met with Colleen Narwot, Facility Administrator who provided a tour of the home in and out. This is a three-bedroom, two-bathroom, single story family residence that includes a living room, dining area, office area, kitchen, laundry area and an attached garage. LPA toured the entire facility and observed the following: Bedroom #1 is not currently occupied, it has one twin size bed, adequate closet drawer space. Bedroom #2 is occupied by one male client, it has one queen size bed, adequate closet and drawer space. Bedroom #3 is occupied by two male clients, it has one twin size bed, and one full size bed adequate walk-in closet and drawer space. Bathroom- there are two bathrooms- one in the main hallway and one located by the master bedroom. Bother bathrooms were clean, sanitary and in working condition. Water temperature was measure to be at 110 degrees. Additional towels are stored in main bathroom. Kitchen/Dining area: There was one (1) refrigerator, microwave, one (1) stove one (1) with five (5) burners, all operable at the time of the inspection. There was a large dining table with four (6) chairs. There is a trash can with a lid in the kitchen area. Knives were observed to locked under double locks above the oven. LPA observed contents of refrigerator and observed three Tupperware items without date, which were immediately discarded. All other contents of refrigerator met regulations.Fruit was observed on counter. Laundry Room: There is a laundry room in the garage equipped with a sink, one (1) washer and one (1) dryer. Laundry chemicals are locked up in cabinets above laundry units. Continue on LIC809-C Living Room: The living room has a tv mounted on the wall and protected by a plastic case. Meds were observed to be locked and accessible only to employees supervising stored medications. Home has working smoke alarms, carbon monoxide detectors and working fire extinguishers at the time of this inspection. The facility has a working telephone/landline. There is no bodies of water on the premises. Facility is clean and sanitary. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Menu is posted with dates in the kitchen. Outdoor space is free of debris and hazard and is kept clean and orderly. Hazardous cleaning solutions, disinfectants, poisons are kept locked in cabinet below kitchen sink. The facility has a Chrysler Pacifica 2020 to transport clients. Current automobile insurance is with National Union Insurance Company. LPA confirmed current registration and insurance. LPA observed that vehicle has functioning windshield wipers, break lights, headlights, first aid kit, and functional horn. Records: LPA reviewed LIC Personnel Report and confirmed that S1 does not have a background clearance and was observed to be working on shift during the time of inspection. LPA inquired about reason for S1 not having clearance and FA explained that S1 was recently re-fingerprinted and confirmation of a clearance was not obtained prior to S1 working on shift. LPA informed FA of violation and FA agreed. FA informed S1 immediately that she needed to leave the facility. Further, LPA reviewed medication logbook/electronic records for C1, C2, and C2 and observed that staff S2 did not document provision of medication on 7/4/23 and 7/11/23 for C1, C2, and C3. LPA observed that medication had been dispersed from bubble packs but was not documented in record to reflect disbursement. LPA inquired with FA about reason for missing documentation and FA stated that there was not a clear explanation why documentation was not completed. LPA informed that facility would be cited for medication documentation error and FA agreed with deficiency. Due to time constraints, LPA will return to review the client/staff files in order to complete annual review. Per California Code of Regulations, Title Regulations, Division 6, chapters 5, there are two deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was emailed to the facility administrator.


summary: Facility Evaluation

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Narrative:
On November 15, 2023 at 1: PM, Licensing Program Analyst (LPA) Regina Martin met with the facility Director Eva Valentin, in order to assess an Enhanced Civil Penalty (ECP). On September 20, 2023, the Department concluded a complaint investigation alleging that Staff did not provide medical attention in a timely manner leading to the questionable death of Client #1 (C1). The investigation findings were determined substantiated, and the Group Home was cited for the violation of Title 22, California Code of Regulations Section 84078(b), Responsibility for Providing Care and Supervision. See the Confidential Names List, LIC 811, dated September 20, 2023. Based on the analysis of the interviews and record reviews, the Department has determined that this violation is warranted for staff negligence to a child in care. The Penal Code Section 11165.6 defines child abuse or neglect as a physical injury or death inflicted by other than accidental means upon a child by another person. Pursuant to the Enhanced Civil Penalty law, Health & Safety Code Section 1548(e), the Department will be issuing an immediate civil penalty of $7,500.00. An exit interview was completed, and appeal rights discussed. A copy of this report, the Confidential Names List, and a Civil Penalty Assessment - Serious Bodily Injury/Physical Abuse (Form 421-D) were provided to the Facility Director. The signed copy will be retained in the facility file.

met_with: Eva Valentin, Director


summary: Facility Evaluation

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Narrative:
On 02/06/2024 at 12:55PM Licensing Program Analyst(LPA) Jhane Haynes arrived at the above facility for the purpose of conducting a confidential interview with youth currently placed in the home about previous placement. LPA met with Facility Administrator(FA) Colleen Nawrot, who granted access to the home. LPA conducted confidential interview with C1. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility.

met_with: Colleen Nawrot Facility Administrator(FA)


facility_name: REMI VISTA BEAR MOUNTAIN HOME

summary: Complaint Investigation - Substantiated

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Narrative:
Continued from Facility is cited per the Interim Licensing Standards, Article 06. Continuing Requirements, Section 87072(c)(11): Personal Rights A signed copy of this LIC-9099 report, the LIC-9099C, and LIC-9099D were provided to the facility. An exit interview was conducted and the appeal rights were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Hillary Hall arrived unannounced at the facility and met with Briggs Bosworth, Administrative Assistant in person, and Garrett Vargas, Program Facilitator on the phone. The purpose of the visit was to deliver findings for a complaint investigation. The Investigations Branch (IB) conducted the complaint investigation. LPA Hall opened the complaint with the facility on 06/09/2022. IB reviewed relevant records from the facility and investigative reports from Law Enforcement. IB conducted 14 confidential interviews. One staff (S2) witnessed another staff (S1) inappropriately touch a youth in care on two occasions between May and June 2022. The youth is non-verbal and unable to provide information. Additional interviews corroborated S1 exhibited inappropriate sexualized behavior toward staff at the facility and at facilities where S1 was previously employed. Based on IB and the Department's observations, interviews, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 12/28/2022

met_with: Garrett Vargas, Program Facilitator


summary: Complaint Investigation - Substantiated - 1 allegation

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Narrative:
Continued from Records and interviews indicate three clients arrived at school on multiple occasions in clothes that did not fit, were stained, or were inappropriate for school. One client arrived at school with overalls which were too small, would not snap on the sides, and revealed the client's underwear. One client wore pants which were too small and were falling off. On each occasion, school personnel provided the clients with more appropriate clothes which were not returned to the school. Additionally, one client arrived at school with soiled clothes in their backpack. Based on LPM and LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. As both allegations regard Personal rights, only one citation is being issued. Citation per Interim Licensing Standards Section 84072(d)(6)(1)(A) Personal Rights is detailed on 9099D. A signed copy of this LIC-9099 report, the LIC-9099C, and LIC-9099D were provided to the facility. An exit interview was conducted. Appeal rights were provided.

Investigation Findings:
13Licensing Program Manager (LPM) Hillary Hall arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint allegations. LPM met with Neville Kimbrell, Administrator. LPM and LPA's McKinley, Valencia, and Vue conducted the investigation. LPM opened the investigation with the facility on 12/21/22 and an Administrator and one staff were interviewed. LPM conducted a Health and Safety Inspection of the facility and no deficiencies were observed. During the course of the investigation, LPM and LPA's interviewed a total of 7 facility staff, 5 school staff, and a Service Coordinator. Attempts to interview clients were unsuccessful due to client's verbal skills. LPM and LPA McKinley reviewed relevant records from the facility including: Client Roster, Staff Roster, Staff schedule, Staff Training logs, prior complaint history, Serious Incident Reports, Individualized Education Plans, clothing receipts, and Needs and Service Plans for foster youth. LPM also reviewed records from the school. LPM and LPA observed one client to have been changed into different clothes at school when the client arrived in clothes that did not fit. Continued on 9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Margo Castaneda LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 03/06/2023

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

met_with: Neville Kimbrell, Program Facilitator/Administrator


raw_content:
Narrative:
Continued from LPM and LPA's observed more than required amounts of perishable and non-perishable food at the facility. Menus and grocery lists were detailed, containing nutritious meals for the clients. LPM observed snacks left out for clients that had not been finished, by the client's own choosing. Interviews were consistent that one client had a diagnosis of PICA, which means the client tends to eat items off the ground or out of the garbage. Interviews indicate this behavior rarely exists at the facility, with the high level of supervision provided, but the behavior is more evident at the school. Interviews were consistent that the clients do not require diapers during the day, but do use diapers or Pull-Ups at night. Facility staff report consistently cleaning the clients when a toileting accident occurs. There was insufficient evidence to determine if the client's diapers are not changed timely. Based on LPM and LPA's observations, interviews conducted, and record reviews, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report and the LIC-9099C were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Manager (LPM) Hillary Hall arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint allegations. LPM met with Neville Kimbrell, Administrator. LPM and LPA's McKinley, Valencia, and Vue conducted the investigation. LPM opened the investigation with the facility on 12/21/22 and an Administrator and one staff were interviewed. LPM conducted a Health and Safety Inspection of the facility and no deficiencies were observed. During the course of the investigation, LPM and LPA's interviewed a total of 7 facility staff, 5 school staff, and a Service Coordinator. Attempts to interview clients were unsuccessful due to client's verbal skills. LPM and LPA McKinley reviewed relevant records from the facility including: Client Roster, Staff Roster, Staff schedule, Staff Training logs, prior complaint history, Serious Incident Reports, Individualized Education Plans, menus, grocery lists, and Needs and Service Plans for foster youth. LPM also reviewed records from the school. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Margo Castaneda LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 03/06/2023

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

met_with: Neville Kimbrell, Administrator


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Narrative:
Continued from The facility submitted a Serious Incident Report to the Department dated 1/2/23 with follow up on 1/3/23, describing an interaction between one client and staff, witnessed by a second staff. The facility immediately interviewed involved parties and provided corrective action, prior to the Department investigating. The incident involved a client having a physically aggressive tantrum and threatening the safety of other clients and staff. One staff held the bedroom door closed for the client for "several minutes" until the client calmed down, which is a violation of the client's personal rights. Bedroom doors in the facility do not have locks. The facility completed a Corrective Action Plan with staff along with additional training on Personal Rights before allowing the staff to return to work. Based on LPM and LPA's observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation, Staff did not treat minor with respect due to holding the client's door closed, is found to be SUBSTANTIATED, per Title Section 84072(d)(14). As the facility already completed a Corrective Action Plan with the staff, a citation is not being issued. No further plan of correction required. A signed copy of this LIC-9099 report and the LIC-9099C were provided to the facility. An exit interview was conducted. Appeal Rights provided

Investigation Findings:
13Licensing Program Manager (LPM) Hillary Hall arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint allegations. LPM met with Neville Kimbrell, Administrator. LPM and LPA's McKinley, Valencia, and Vue conducted the investigation. LPA Valencia opened the investigation with the facility on 1/12/23 and an Administrator was interviewed. LPA Valencia conducted a Health and Safety Inspection of the facility and no deficiencies were observed. During the course of the investigation, LPM and LPA's interviewed a total of seven facility staff, five school staff, and a Service Coordinator. Attempts to interview clients were unsuccessful due to client's verbal skills. LPM and LPA McKinley reviewed relevant records from the facility including: Client Roster, Staff Roster, Staff schedule, Staff Training logs, prior complaint history, Serious Incident Reports, Individualized Education Plans, and Needs and Service Plans for foster youth. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Margo Castaneda LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 03/06/2023

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


raw_content:
Narrative:
Continued from The facility submitted a Serious Incident Report to the Department dated 1/2/23 with follow up on 1/3/23, describing an interaction between one client and staff, witnessed by a second staff. The facility immediately interviewed involved parties and provided corrective action prior to the Department investigating. The incident involved a client having a physically aggressive tantrum and threatening the safety of other clients and staff. Interviews were consistent that the staff did raise his voice. Reports were inconsistent as to whether the staff yelled or made negative or derogatory comments to the client. The facility completed a Corrective Action Plan with the staff along with additional training on Personal Rights before allowing the staff to return to work. Interviews and records indicate a client named in the Serious Incident Report has a pattern of "grazing" on food throughout the day. The facility provides three meals per day, with snacks in between meals. The client in the incident report requested an additional snack. Not all interviews were consistent regarding the details of the client requesting an additional snack and being denied. One staff reported the client was initially denied the extra snack, then later given the extra snack. LPM and LPA's observed more than the required amount of perishable and non-perishable food at the facility during the inspection. LPM also observed during the inspection, that the client in the incident had been offered a snack, and left it uneaten by his own choosing. Based on LPA's observations, interviews that were conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report and the LIC-9099C were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Manager (LPM) Hillary Hall arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint allegations. LPM met with Neville Kimbrell, Administrator. LPM and LPA's McKinley, Valencia, and Vue conducted the investigation. LPA Valencia opened the investigation with the facility on 1/12/23 and an Administrator was interviewed. LPA Valencia conducted a Health and Safety Inspection of the facility and no deficiencies were observed. During the course of the investigation, LPM and LPA's interviewed a total of seven facility staff, five school staff, and a Service Coordinator. Attempts to interview clients were unsuccessful due to client's verbal skills. LPM and LPA McKinley reviewed relevant records from the facility including: Client Roster, Staff Roster, Staff schedule, Staff Training logs, prior complaint history, Serious Incident Reports, Individualized Education Plans, menus, grocery lists, and Needs and Service Plans for foster youth. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Margo Castaneda LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 03/06/2023

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


raw_content:
Narrative:
Continued from Facility staff report the clients are assisted with bathing daily. Records and additional interviews indicate two clients arrived at school on multiple occasions with a strong odor, appearing as though they had not bathed. Clients needed to be cleaned by school staff on arrival at school. Additionally, one client arrived at school with soiled clothes in their backpack. The school documented one client had oily hair and another had dandruff, despite the facility reporting the clients showered daily. Interviews indicate the clients are able to shower themselves, but need step by step assistance. While the clients did get baths, the frequency and quality of the bathing was not adequate. Based on LPM and LPA's observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation, Staff did not bathe minor is found to be SUBSTANTIATED. Citation per Title Section 84078(b)Responsibility for Care and Supervision is documented on LIC-9099D. A signed copy of this LIC-9099 report, the LIC-9099C, and LIC-9099D were provided to the facility. An exit interview was conducted. Appeal rights were provided.

Investigation Findings:
13Licensing Program Manager (LPM) Hillary Hall arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint allegations. LPM met with Neville Kimbrell, Administrator. LPM and LPA's McKinley, Valencia, and Vue conducted the investigation. LPA Valencia opened the investigation with the facility on 01/12/23 and an Administrator was interviewed. LPA Valencia conducted a Health and Safety Inspection of the facility and no deficiencies were observed. During the course of the investigation, LPM and LPA's interviewed a total of 7 facility staff, 5 school staff, and a Service Coordinator. Attempts to interview clients were unsuccessful due to client's verbal skills. LPM and LPA McKinley reviewed relevant records from the facility including: Client Roster, Staff Roster, Staff schedule, Staff Training logs, prior complaint history, Serious Incident Reports, Individualized Education Plans, and Needs and Service Plans for foster youth. LPM also reviewed records from the school. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Margo Castaneda LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 03/06/2023

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Continued from One witness reported observing a client be grabbed by the arms, pulled up off the ground, and yelled at within close range by a facility staff when the client refused to leave school campus. The client's escalated behavior diminished after school staff intervened. Another witness observed from a distance but could not hear the verbal exchange. The incident was not reported timely making details inconsistent. The staff alleged to have grabbed and yelled at the youth denied the allegations. Record Review and Interviews with other facility staff indicate the alleged staff who grabbed the youth was very professional and was highly rated at the facility. Based on LPA's observations, interviews, and record reviews, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report and the LIC-9099C were provided to the facility. An exit interview was conducted. *Amendment created to include staff's denial of allegations.

Investigation Findings:
13Licensing Program Analyst (LPA) Lyta Vue and Licensing Program Manager (LPM) Hillary Hall arrived unannounced at the facility on 04/26/23 for the purpose of delivering findings for the complaint investigation. LPA and LPM met with Neville Kimbrell, Administrator. LPAs Vue, Misty Valencia, and Wendy Brown, as well as Licensing Program Manager (LPM) Hillary Hall conducted the complaint investigation. LPAs Vue and Valencia opened the investigation with the facility on 02/02/23 and interviewed facility administrator. LPAs conducted a Health and Safety Inspection. During the course of the investigation, LPAs conducted interviews with three facility staff, one service provider, and two other confidential individuals. LPA's were unsuccessful in conducting interviews with five clients. LPA Vue reviewed relevant records from the facility including Staff training, staff schedule, personnel records, Needs and Service Treatment Plans, Placement Roster, prior complaint history, Serious Incident Reports, and other supporting Assessment Records. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Margo Castaneda LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 04/26/2023


raw_content:
Narrative:
Text messages indicate that one minor was visibly sick with a fever at school on 02/09/23 and the facility staff was notified. The school staff stated during interviews that the minor was picked up. In March, there were multiple days the clients appeared to be sick at school, but it was not documented, and the facility was not always notified to come pick them up. Upon interview and records reviewed, the Client Personal Property Safeguarded Items records showed that the logs were dated through March of 2023 of clothing purchased and personal property provided as needed. LPA observed the minor's health and appearance to be healthy and maintained. The minors were dressed appropriately and clean. LPA completed a Health and Safety Home Inspection and observed the clients to have clothes drawers in the client's room to be filled with clothes and other personal items such as socks and underwear. Based on LPA's observations, interviews, and record reviews, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report and the LIC-9099C were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility on 05/30/23 for the purpose of delivering findings for the complaint investigation. LPA met with Chris Magera, Program Manager. LPA Lyta Vue conducted the complaint investigation. LPA opened the investigation with the facility on 03/30/23 and the Behavioral Case Manager (BCM) was interviewed. A Health and Safety Inspection was conducted. During the course of the investigation, LPA interviewed one facility staff, and two other confidential individuals. LPA attempted interviews with two youth. LPA reviewed relevant records from the facility including staff training, staff schedule, Client Quarterly Progress Report, Placement Roster, prior complaint history, Serious Incident Reports, and Individual Client Inventory records. Record review provided no evidence the facility allowed minors to go to school when visibly sick. There was inconsistent information provided in interviews. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Lyta Vue 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: REMI VISTA BEAR MOUNTAIN HOMEFACILITY NUMBER: VISIT DATE: 05/30/2023

met_with: Program Manager (PM)


facility_name: REMI VISTA ROCAFORT HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Katherine Deaton and Kellie McKinley conducted an annual inspection at the facility address located above. The facility is clean, safe, and sanitary. The LPAs conducted two staff interviews. There were no clients in the home at the time of the facility inspection. The LPAs requested verification that the first aid and emergency disaster kits were complete. Although all first aid components were identified, it took staff a few minutes to locate two components. The LPAs informed staff that an Advisory Note - Technical Violation would be issued. The LPAs left the facility at approximately 1:30pm and traveled to the Administrative Office located at Churn Creek Rd, Redding, CA to conduct the file review. The LPAs reviewed all three client files and interviewed two clients. The LPAs began the staff file review. Due to time constraints this inspection will be completed at a later date. No citations have been issued.

met_with: Chris Magera


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Katherine Deaton and Kellie McKinley completed the annual inspection at the Administrative Office located at Churn Creek Rd, Redding, CA to complete the file review and conduct an exit interview. The LPAs reviewed four staff files. One staff did not have a Health Screen or TB test as they were hired 11 years ago and the documentation was not readily available at the time of inspection. The facility now maintains this information in a cloud-based system. The LPAs conducted an exit interview with Chris Magera, Program Coordinator and reviewed the Advisory Notes for Technical Violations Title Section 80075(g)(1)(A), Section 84361(f), and Section 84065(i)(1)(D). No citations were issued throughout the course of this inspection.

met_with: Chris Magera, Program Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Misty Valencia arrived unnanounce at the facility and met with Alisha Ashby, Facility Manager (FM), and Karson Van-dyke residential counselor (RC) of Remi Vista Rocafort Home. The purpose of the contact was to initiate a Case Management Inspection following up on four incident reports LPA received from the facility between 6/19/2023 and 06/26/2023 relating to client medication errors. LPA requested the following documents from the facility: Procedures on medication administration and description of training Verification of staff training on medication administration procedures (that will be completed 07/05/2023) Corrective Action Plan for Staff that completed errors On 06/19/2023- Client 1 (C1) #1 was on a home pass 06/14/2023 and was not given prescribed Benztropine 1mg medication and Topiramate 25mg. LPA and FM talked about completing a medication training for family and a separate MARS form for weekend home visits, which Far Northern Regional Center recommended as well. On 06/19/2023-C1 did not receive his morning medications Neutrogena oil-free acne wash 2% to be used twice a day. Take for ACNE Atomoxetine 40MG Take 1 capsule by mouth every morning. Take for ADHD Benztropine 1MG Take 1 tablet by mouth twice daily. Take for Tremors Pimozide 1MG Take 1 tablet by mouth twice daily. Take for tics Topiramate 25MG take 3 caps by mouth twice daily. Take for Seizures Ziprasidone 60MG Take 1 capsule by mouth twice daily. Take as Antipsychotic, due to staff error. continued on 809-C On 06/21/2023-C1 did not receive his prescription medication Gabapentin Cap Mg for bedtime due to the house did not have a refill of the medication provided, staff error. FM reported that a med count was completed on Sunday 06/18/2023 and was known to be limited and a refill should be completed. FM reported that from now on there will contact the medical coordinator to coordinate med refills. On 06/19/2023-Client 2 (C2) did not receive his morning medication Clonidine 0.1MG take 1 tablet by mouth twice daily for ADHD due to staff error. FM reported that morning was very hectic and everything was just not communicated very well. FM reports that from now on the staff coming on will communicate with the staff leaving so they know who received their meds and who didn't. A copy of this report has been provided to the facility. No citations issued.

met_with: Alisha Ashby, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
07/13/2023, Licensing Program Analyst (LPA) Misty Valencia and Lyta Vue arrived unannounced at the facility and met with Arieanna (ARI) Flores, Residential Youth Counselor. The purpose of the visit was to conduct a Required Annual Inspection of the facility. The last Annual inspection for the facility was on 08/24/2021. LPA utilized the CARE Tool to complete the Annual inspection. The facility is licensed to provide treatment services for ambulatory children ages 13-18years. The facility currently has four (4) clients, all Regional Center placements. Four (4) client(s) were present during the inspection. The facility is licensed for a maximum capacity of four (4). Staff to client ratio is two (2) to four (4). LPA conducted an inspection of the physical plant, and checked for all necessary requirements. The facility had no noticeable odor and maintained an acceptable room temperature. There are a total of four bedrooms available for clients, with each client having their own bedroom. LPA observed the client bedrooms, living rooms, kitchen, two bathrooms, the backyard, the garage, and the staff office to be clean and organize. LPA observed each client bedroom to have a closet, a dresser, and a clean mattress. Sheets, blankets, and pillows were in good condition. Every bedroom was decorated with the client's personal items. LPA observed a locked medication where medications are stored. Client files were stored at the main office off site electronically. LPA observed the proper postings including: facility license, complaint hotline, menu, and emergency disaster plan. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. The facility has no outstanding fees. LPAs observed 2 days of perishable food and 7 days of non-perishable food in the kitchen and in the additional refrigerator in the garage. Disinfectants and cleaning solutions were stored in the medication room cabinet inaccessible. continued on 809-C

met_with: Arieanna (ARI) Flores, Counselor


summary: Facility Evaluation

raw_content:
Narrative:
On 08/15/2024, Licensing Program Analysts (LPA) Misty Valencia and Lyta Vue arrived unannounced at the facility and met with Chris Magera, Administrator. The purpose of the visit was to conduct a Required Annual Inspection of the facility. The last Annual inspection for the facility was on 07/13/2023. LPA utilized the CARE Tool to complete the Annual inspection. The facility is licensed to provide treatment services for ambulatory children ages 13-18years. The facility currently has four clients, all Regional Center placements. One client was present during the inspection. The facility is licensed for a maximum capacity of four. Staff to client ratio is two to four. LPA conducted an inspection of the physical plant, and checked for all necessary requirements. The facility had no noticeable odor and maintained an acceptable room temperature. There are a total of four bedrooms available for clients, with each client having their own bedroom. LPA observed the client bedrooms, living rooms, kitchen, two bathrooms, the backyard, the garage, and the staff office to be clean and organize. LPA observed each client bedroom to have a closet, a dresser, and a clean mattress. Sheets, blankets, and pillows were in good condition. Every bedroom was decorated with the client's personal items. LPA observed a locked medication room where medications are stored. Client files were stored at the main office off site electronically. LPA observed the proper postings including: facility license, complaint hotline, menu, and emergency disaster plan. Smoke alarm was in working order, fire extinguishers were current, and a first aid kit was fully stocked. The facility has no outstanding fees. LPAs observed 2 days of perishable food and 7 days of non-perishable food in the kitchen and in the additional refrigerator in the garage. Disinfectants and cleaning solutions were stored in the medication room cabinet inaccessible. continued 809-C LPAs reviewed four client files. Four clients were taking psychotropic medications and had current parental consent on file. Psychotropic medication logs for clients were written on separate Psychotropic Medication Administration Records. Clients were current on CHDP physical exams and dental exams. The client's Needs and Services Plan/Individual Program Plan, were complete and up to date. LPAs reviewed five staff files. Staff files had completed criminal record clearances and all required initial and annual training. First Aid and CPR certifications were up to date for all staff. Administrators Certificate was valid. LPA interviewed two staff on site. LPA interviewed one client, three other client were not at the facility and were in school. No citations were given on this date. A signed copy of this LIC-809 and LIC-809C, report was provided to Administrator An exit interview was conducted.

met_with: Chris Magera, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/19/2025, Licensing Program Analysts (LPA) Misty Valencia arrived unannounced at the facility and met with Chris Magera, Administrator. The purpose of the visit was to conduct a Required Annual Inspection of the facility. The last Annual inspection for the facility was on 08/16/2024. LPA utilized the CARE Tool to complete the Annual inspection. The facility is licensed to provide treatment services for ambulatory children ages 13-18 years. The facility currently has four clients, all Regional Center placements. Four clients were present during the inspection. The facility is licensed for a maximum capacity of four. Staff to client ratio is two to four. LPA conducted an inspection of the physical plant, and checked for all necessary requirements. The facility had no noticeable odor and maintained an acceptable room temperature. There are a total of four bedrooms available for clients, with each client having their own bedroom. LPA observed the client bedrooms, living room, kitchen, two bathrooms, the backyard, the garage, and the staff office to be clean and organize. LPA observed each client bedroom to have a closet, a dresser, and a clean mattress. Sheets, blankets, and pillows were in good condition. Every bedroom was decorated with the client's personal items. LPA observed a locked medication room where medications are stored. Client files were stored at the main office off site electronically. LPA observed the proper postings including: facility license, complaint hotline, menu, and emergency disaster plan. Smoke alarm was in working order, fire extinguishers were current, and a first aid kit was fully stocked. The facility has no outstanding fees. LPA observed 2 days of perishable food and 7 days of non-perishable food in the kitchen and in the additional refrigerator in the garage. Disinfectants and cleaning solutions were stored in the medication room cabinet inaccessible. continued 809-C page LPA reviewed four client files. Four clients were taking psychotropic medications and had current parental consent on file. Psychotropic medication logs for clients were written on separate Medication Administration Records. Clients were current on CHDP physical exams and dental exams. The client's Needs and Services Plan/Individual Program Plan, were complete and up to date. LPA reviewed five staff files. Staff files had completed criminal record clearances and all required initial and annual training. First Aid and CPR certifications were up to date for all staff. Administrators Certificate was valid. LPA interviewed two staff on site and LPA interviewed two clients, two clients were bedrooms sleeping. No citations were given on this date. A signed copy of this LIC-809 and LIC-809C report was provided to Administrator An exit interview was conducted. Page 2

met_with: Chris Magera, Administrator


facility_name: RHOG CARE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Lyta Vue, Yesenia Vallejo, Licensing Program Manager (LPM) Hillary Hall, and Regional Manager (RM) Margo Castaneda met with Abidemi Olatunbosun, Tunde Balogun, Matthew Erilim, and Uchenna Ajaero at 10: AM for a scheduled Component 2 meeting for the Application for RHOG CARE HOMES GROUP HOME. The meeting was held in the CCLD Office located at Cohasset Rd., Chico, CA. RM and LPM discussed revisions needed to the A and B documents. The applicants agreed to provide the revisions to the application to the Department within 30 days. If the applicants need more time, they can request for it. RM and LPM also provided the application for the Regional Center. An approved Program Statement was reviewed in person with the applicant. A signed copy of this 809 was provided to the applicants.

met_with: Tunde Balogun


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue conducted an announced Pre-licensing Inspection on 10/06/25 at 8: AM at the above location, as required for the Group Home (GH) licensure. LPA met with Matthew Erilim, Administrator (AMIN) and Babatunde Balogun, Chief Executive Officer (CEO). During the pre-licensing visit, LPA conducted a Health and Safety Inspection using the CARE tool. LPA observed the facility to be clean inside and safe. The outside of the facility is fenced in the backyard, spacious, clean and well maintained for outdoor activities. LPA observed that there is one (1) floor to the facility. LPA observed five bedrooms of which four (4) are client bedrooms, equipped with appropriate furniture, bedding, and supplies for clients. Sufficient storage space for client's personal belongings was observed in each room. The facility is requesting to be licensed for six (6) clients. One (1) staff is hired but staff will work according to ratio. LPA observed a medication locked box stored and locked in the locked pantry and a medication fridge which was empty, but locked which is made accessible only to designated staff. The kitchen area was equipped with an adequate number of utensils, dining supplies, and cups for clients. No food was observed as there are no clients, and no pending placements at this time. Facility will verify required food on hand at time of client placement. LPA observed a staff office space that is locked and inaccessible to clients, where client records will be locked in file cabinets. Facility has a garage used for maintenance supplies and is locked and made inaccessible for clients. LPA observed a laundry room with a locked door with all cleaning supplies are store high in cabinets. Inspection report continues on 809c The smoke detectors and carbon monoxide were tested and found to be functional during the inspection. Two (2) fire extinguishers were present and will expire 12/09/25. A fully equipped first aid kit was in the kitchen area. The Foster Youth Bill of Rights was posted in a conspicuous location. There are three (3) bathrooms in the facility, of which two (2) are accessible for client use and one (1) for staff. The water temperature was tested and found to be DEGREES. The facility is ready for licensure as a Group Home and LPA recommends that the facility be licensed. A signed copy of this report was provided to Matthew Erilim, Administrator.

visit_type: Prelicensing

met_with: Matthew Erilim, AMIN Babatunde Balogun, CEO


facility_name: RICKY'S RESIDENTIAL

summary: Facility Evaluation

raw_content:
Narrative:
On August 10, Licensing Program Analyst Stephannie Verna conducted an announced pre-licensing facility inspection and met with Desiree Clifton, Facility Administrator and announced the reason for the inspection. Desiree Clifton, Facility Administrator assisted with the inspection. LPA and the Administrator conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The group home is requesting to be licensed for a capacity of 3 ambulatory clients, ages seven to 17 years old. There were no clients in care at the time of the inspection. Clients with Special Health Care Needs (SHCN) will not be admitted. The home is a one story home. The home consists of three single occupancy bedrooms and two bathrooms, a garage, and a backyard with a swimming pool. The home has a home security alarm system installed, there are no video cameras as part of the security system. The front and back yards were free of clutter; and the passageways and egress were unobstructed. No potentially hazardous items or areas were observed. The backyard contains a swimming pool, a seating area with a table and multiple chairs, gazebo to shade from the sun and a barbecue. Pool fencing surrounding the pool was of adequate height, had a self-closing and latching gate, and was within regulation. continued on 809-c LPA observed that the bedrooms had a single bed and bedding including mattress cover, fitted sheet, top sheet and blanket, desks with drawers for personal items, night stand, lamp, and ample closet area. The living room consisted of two couches and a television, and a shared sitting area/activity area consisted of two chairs and a desk, a television and computer with internet access. The facility had a working land line and the phone was located on an end table in the living room. LPA also observed activity supplies in the sitting area, including coloring supplies, paint supplies, a game, books and an exercise bike. The sitting area contained a screened fire place, that was not in working order. The sitting room was located down one step and was at a lower level than the living and dining area, and there are support bars installed on the wall in the doorways to the lower level. There was one bathroom which was observed to be on the lower level and was equipped with a shower and a shower curtain for privacy. The bathroom had a working toilet, shower, and sink faucet. The second bathroom was located at the rear of the hallway in the home and was observed to have a bathtub, working toilet, bath faucet and sink faucet. The water temperature was measured to be at 108.8 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. The hallway closet outside of the bathroom contained extra towels and wash cloths. LPA observed that the dining area was off of the kitchen and the table was set up for placement of four and contained four chairs. LPA observed that the kitchen area was located off the dining and living room area of the facility and that the kitchen area had the stove, refrigerator, and oven. The pantry was located off of the kitchen in the hallway, with no lock on the door. The facility will ensure that the pantry and kitchen are stocked with ample food prior to accepting placement of clients. continued on 809-c There was also a refrigerator and freezer located in the garage for extra storage of food, and the freezer was stocked with frozen foods. LPA observed that there were ample dishes, cups, utensils, and items used for cooking meals in the kitchen. Sharps are to be kept in a drawer in the kitchen and this drawer was secured by a locking system. Cleaning supplies and chemicals are to be stored under the kitchen sink and in the garage cabinet, which are also secured by a locking system. Menus and meal schedules were posted in the kitchen. LPA observed that the medications and confidential client and staff files, including the Register of Clients, are to be stored in the cabinet in the lower level of the home, across from the bathroom and near the garage door. This cabinet contained multiple first aid kits and other first aid supplies as well as cubbies to hold client medications. LPA observed that this cabinet has a locking mechanism and will not be accessible to clients in care. This cabinet also stored extra hygiene products for the clients, bathroom caddies, and included soap, toothbrushes, razors, lotion, and shampoo. LPA observed that there was a laundry area, including a washer and dryer, in the garage. The garage contained multiple cabinets which were empty, stored life vests for the pool, extra bedding and comforters and/or were locked and stored cleaning supplies, and pool chlorine. The home had an Emergency Disaster plan, and Facility Sketch posted in multiple areas of the home. Client Personal Rights and the Grievance policy were posted in the hallway, along with a calendar of activities. continued on 809-c LPA observed a working Carbon Monoxide detector in the hallway and working smoke alarms in each bedroom, the dining area, and a living area. LPA observed that there was a fire extinguisher in the kitchen and the lower level sitting area. The fire extinguished were charged and last inspected in April 2022. The fire clearance was posted in the hallway. The facility was clean, safe, sanitary and in good repair. All reviewed elements of physical plant of home are compliant with Title Regulation and Health and Safety Codes. The program statement and application are complete and approved. The facility is prepared for licensure and pending Licensing Program Manager's Approval. An exit interview was conducted with Desiree Clifton, Facility Administrator and a copy of this report was left with Clifton, Facility Administrator.

met_with: Desiree Clifton, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/30/ Licensing Program Analyst (LPA) Jean Stidman met with Desiree Clifton, Administrator for the purpose of conducting a Post Licensing Inspection LPA completed the Physical Plant inspection.. LPA will complete the inspection at a later date. LPA conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection (no clients in placement and no staff present) Number of staff interviewed 1. LPA observed #3 bedrooms, # 2 bathrooms I. Physical Plant Posting of license_X_ Personal Rights_X____ Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F __X_ Freezer Temperature at or below 0 degrees__X___ Nonperishable Foods one week and fresh perishable foods two days minimum_N/A Menu present and posted___N/A___ Working telephone __X___ Carbon monoxide detectors ___X__Smoke Detector __X__ First Aid Kit fully stocked_X__ Common Room available__X___ Dining area (enough seating, furniture good condition, not broke or damaged) __X__ Medication centrally stored, locked/inaccessible _N/A__ Office (locked and privacy) N/A____ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__X___ Fire Extinguisher (note inspection date) _April 2022__ Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _X___ Soap and Paper towels _X_____ Laundry Facilities(available, work assign dates) __X___ Bedrooms-required linen and furnishings ___X__ Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts__N/A_ Facility free of vermin _X____ Locked Facilities (open locked storage area/building/sheds) ___N/A Bedroom (required bedding/furniture, furniture in good repair) ___X__ A copy of this report was left with Desiree Clifton, Administrator

met_with: Desiree Clifton, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 2/8/ Licensing Program Analyst (LPA) Jean Stidman met with Desiree Clifton Administrator for the purpose of a Post Licensing Inspection. LPA inspected the facility inside and outside. The facility has no clients in placement. No violations were cited. LPA and Administrator reviewed the facility application list of revisions needed. LPA provided Technical Assistance on revisions needed. A copy of this report was left with Desiree Clifton, Administrator.