summary: Facility Evaluation

raw_content:
Narrative:
On March 30, 2023 at 9: AM, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced inspection at the facility above. LPA met with Program Administrator(P1) Levy Middlebrooks and Program Representative (P2) Otilli Abuka. The purpose of the inspection is to conduct a required annual inspection. The facility is a single-family home, with four client individual bedrooms, two bathrooms, dining room, living room, kitchen, laundry room, staff office and garage. LPA inspected physical plant, operational requirements, disaster preparedness, emergency intervention plan, reviewed five of five staff files, two of two client files (see confidential name list, LIC811, dated 03/30/2023) and interviewed two of two staff. Two of two clients were unable to be interviewed due to verbal limitations. The staff and client files are stored and locked on-site. Bedrooms are arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. There is sufficient linens, blankets, towels and pillows. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly stored and made inaccessible. The medications are locked in the living room cabinet. There is a lockbox for refrigerated medications available. The garage is maintained locked and consists of an extra refrigerator, washer/dryer, cleansers/chemicals locked in cabinet and extra PPE locked in a cabinet. Sharp knives were inaccessible and stored in the locked garage cabinet. First Aid kit was accessible and had all required items including the thermometer. There were no guns or weapons as stated by administrator. The hot water temperature was tested and noted to be at 116 degrees and maintained within the regulation range of 105-120 degrees. Trash cans for storage of solid waste had tight fitting lids. (see continuation form LIC 809-C dated 03/30/23) Based on the record review, the licensee did not comply as 5 out of 5 staff (S1-S5) files did not have documentation of successful completion of training maintained in the personnel record for each child care staff, one (C2) of two (C1-C2) clients the facility did not ensure that a separate, complete and current record is maintained in the facility for each client, and two of two clients (C1-C2) do not have a copy of the child's original needs and services plan; verification, signed by the child and their authorized representative(s), that they were offered the opportunity to participate in plan development; and verification that the authorized representative(s) have approved the plan which poses a potential health, safety or personal rights risk to persons in care. The facility is being cited for California Code of Regulations, Title 22: CCR 84065(j)(6), CCR 80070(a) and CCR 84070(c)(2). An exit interview was conducted, and this report, appeal rights and LIC 811 was reviewed with Program Administrator Levy Middlebrooks and a copy of this report was provided.


state: CA

facility_name: PEOPLE'S CARE RESMAR

summary: Facility Evaluation

raw_content:
Narrative:
On March 15, 2024, 2023 at 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced inspection at the facility People's Care. LPA met with Otilli Abuka, Program Representative who provided LPA with an indoor and outdoor tour of the facility. The purpose of the inspection is to conduct a required annual inspection. The facility is a single-family home, with four client individual bedrooms, two bathrooms, dining room, living room, kitchen, laundry room, and garage. Bedrooms are arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Beds were observed to have appropriate linen and mattress in good repair. There is sufficient linens, blankets, towels and pillows in the hallway closet. Living room was observed with multiple seating and a television. The medications are locked in the living room cabinet. The kitchen was observed to be clean and free from observable hazards. Knives were inaccessible and stored in a safe in a kitchen cabinet. Trash cans for storage of solid waste had tight fitting lids. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Games were observed for clients recreation time. There is a trampoline in the back yard with mesh netting. All facility smoke detectors and carbon monoxide detectors were checked and were working properly; fire extinguishers are properly charged and serviced. The hot water temperature was tested in the bathroom and noted to be at 115.7 degrees, within the regulation range of 105-120 degrees. LPA observed the following items posted Personal Rights, Facility sketch, Activity Schedule, Menu, Staff Schedule and Emergency Plan. Continued... First Aid kit was accessible and had all required items including the thermometer in hallway closet. Additionally, LPA observed seven days of non-perishable food and gallons of water. The garage is maintained locked and consists of an extra refrigerator, washer/dryer, cleansers/chemicals locked in cabinet and extra PPE. There are no guns or weapons as stated by Program Representative. LPA reviewed facility binder, operational requirements, disaster preparedness and emergency intervention plan. The last disaster drill was held on March 2, 2024. LPA reviewed three of three staff files, three of three client files (see confidential name list, LIC811, dated 3/15/2024). LPA interviewed two of two staff and one out of one clients. The staff and client files are stored and locked on-site. Based on today's observations and record review there are no deficiencies noted at this time. An exit interview was conducted and a copy of this signed report was emailed to Otili Abuka, Program Representative.

report_type: Facility Evaluation

visit_type: Annual

met_with: Otilli Abuka, Program Representative


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Joon Choi on July 31, 2024 at 09: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Choi met with Administrator, Otilli Abuka and inspected the facility. Please note: there were no eligible clients to interview nor were there any eligible client files to review. (please see LIC 812 "Eligible Clients) LPA reviewed three of staff personnel files on site at the facility. LPA interviewed two of staff on site to discuss the facilities policies and procedures of operation. LPA provided a copy of this licensing report to Administrator, Otilli Obuka No deficiencies are being cited at this time. LPA conducted exit interview with Administrator, Otili Obuka

visit_type: Case Management

met_with: Otilli Abuka, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2025, at 9: AM, Licensing Program Analysts (LPA's) Lucero Jauregui and Abby Saeteurn conducted an unannounced inspection at the facility People's Care. LPA's met with Otilli Abuka, Administrator who provided LPA's with an indoor and outdoor tour of the facility. The purpose of the inspection is to conduct a required annual inspection. The facility is a single-family home, with four client individual bedrooms, two bathrooms, dining room, living room, kitchen, laundry room, and garage. Bedrooms are arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Beds were observed to have appropriate linen and mattress in good repair. There is sufficient linens, blankets, towels and pillows in the hallway closet. Living room was observed with multiple seating and a television. The medications are locked in the living room cabinet. The kitchen was observed to be clean and free from observable hazards. Knives were inaccessible and stored in a safe in a kitchen cabinet. Trash cans for storage of solid waste had tight fitting lids. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. All facility smoke detectors and carbon monoxide detectors were checked and were working properly; fire extinguishers are properly charged and serviced. The hot water temperature was tested in the bathroom and noted to be at 109.4 degrees, within the regulation range of 105-120 degrees. LPA's observed the following items posted License, Personal Rights, Facility Sketch, Meal Menu, and Emergency Plan. Continued... First Aid kit was accessible and had all required items. Additionally, LPA's observed seven days of non-perishable food and gallons of water. The garage is maintained locked and consists of an extra refrigerator, washer/dryer, cleansers/chemicals locked in cabinet and extra PPE. There are no guns or weapons as stated by Administrator. LPA's reviewed facility binder, operational requirements, disaster preparedness and emergency intervention plan. LPA's reviewed five staff files, three of three client files (see confidential name list, LIC811, dated 3/5/2025). The staff and client files are stored and locked on-site. Based on today's observations and record review there is four Technical Violations issued at this time: 80088(b), 80070(b)(6), 84070(c)(1) and 84068.1(b)(4)(A) [SEE LIC9102]. An exit interview was conducted and a copy of this signed report and appeal rights were provided to Otili Abuka, Adminstrator.

met_with: Otili Abuka, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 09, 2021 at 1: PM, Licensing Program Analyst (LPA) Marisol Lopez conducted a case management and met with Program Administrator Levy Middlebrooks. LPA conducted a safety inspection of the facility, and no safety hazards were observed. The case management is in response to medication records reviewed at the facility. Client's (C1, C2, C3)psychotropic medications were not listed on a separate log for each psychotropic medication prescribed for the child which posed a potential Health, Safety or Personal Rights risk to clients in care. Based on facility records review, the facility is being cited for California Code of Regulations, Title Health & Safety Code section: 1507.6(b)(2)(B). An exit interview was conducted. A copy of this report was provided to Program Administrator Levy Middlebrooks along with appeal rights and LIC 811 (See Confidential Names List- LIC811 dated 11/09/2021).

met_with: Levy Middlebrooks


summary: Facility Evaluation

raw_content:
Narrative:
On July 2, 2024, at 2: PM, Licensing Program Analyst (LPA) Lucero Jauregui went to People's Care Resmar and met with Otili Obuka, Administrator to assess a Civil Penalty regarding fingerprint clearance. On December 19, 2023, LPA Jauregui conducted an inspection of the facility and observed that one staff that did not have a criminal record clearance prior to working at the facility. The information was verified through CCL Guardian system and LPA informed the facility that facility that staff did not have a criminal record clearance to be present and providing care and supervision to the clients. Therefore, the facility is being cited for the violation of California Code of Regulations, Title 22, Division Chapter Article 03. Application Procedures for Criminal Record Clearance 80019(e)(2) (See LIC 9099D). An exit interview was conducted with Otili Obuka, Administrator. A copy of this report and appeal rights were provided to Otili Obuka, Administrator.

met_with: Otili Obuka, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 9, 2024 at 09: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced to conduct a Case Management visit and met with Kara Viliamu, Facility Manager. Community Care Licensing received a Special Incident Report (SIR) from the facility, dated 10/4/24, in which it was reported that C1 gained access to the medication cabinet due to staff not properly locking the cabinet, and C1 consumed 4 doses (40mg) of melatonin. Based on interview and record review, the facility did not ensure centrally stored medications were inaccessible to clients in care. This posed an immediate health, safety, or personal rights risk to clients in care. The facility is being cited for violation of Title 22, Division 6, Chapter 1, Article 06. Continuing Requirements 80075(k)(1) Health Related Services (See LIC9099D). An exit interview was conducted and a plan of correction was developed with Kara Viliamu, Facility Manager. A copy of this report and appeal rights were provided to Kara Viliamu, Facility Manager.

met_with: Kara Viliamu, Facility Manager


facility_name: PEOPLE'S CARE SHAWMUTT

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
C1 stated, she AWOL'S because she is unhappy because she wants to go home to her family. C1 stated, when the Covid 19 started, her friends that were in the facility went home to their families, and she felt sad that she had to stay in the facility. C1 denied that the staff hits her. Alta Regional Caseworker stated that they are providing additional staff 1:1 for C1. Alta stated they feel that the facility is trying their best to meet the needs of C1, but when Covid 19 started C1 behaviors started due to her friends going home to their families and she stayed at the facility. CSW stated, that the group home is denying the client food and is not offering her alternatives and there is a lack of planned activities in the facility. The CSW stated, C1 is left out of games at the facility and has to entertain herself. The reporting party stated that the staff is not supervising C1 when she rides her bike around the neighborhood. C1 stated, the Staff always follows me each time I AWOL'S and is always being supervised and followed. C1 stated, it makes me angry because she wants to go home, and staff is always following her around. Mental health worker stated that C1 stated that a staff hit her but could not state the date or time frame. C1 denied she gets hit by staff. CSW stated that the staff are not assuring C1 is going to school. C1 stated, she doesn't want to go to school and it's her personal right not to go to school and they can't make her. S1, S2 and S3 stated, that they engage with C1 by playing board games, taking her to outings and encouraging her to go school by buying her clothing and snacks to encourage her to go to school. The staff stated that the day that C1 did go to school, C1 assaulted a teacher and C1 was suspended from school. The staff also stated if C1 doesn't like something in the menu, then C1 has a choice to cook something for herself and they will assist her. C1 enjoys cooking. Staff also stated they are always following C1 when she AWOL'S and try to direct and encourage her to return to the home. Administrator stated, the staff and herself are trying and encouraging the client to work the program. However, when her friend that lived in the facility left to go to live with their families due to Covid 19, C1 got depressed and jealous that her friend had a family and she didn't. Administrator stated she has requested a 30 day notice due to C1 behaviors but CSW has not found a place for her. Based on LPA's observations, interviews which were conducted, and records received the preponderance of evidence stand has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence standard to prove the alleged violation did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted with Administrator.

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

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

report_type: Complaint Investigation

met_with: Rodina Ventura, Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Based on the information obtained, the allegation is determined to be UNSUBSTANTIATED. It was reported that C1 appeared to be in distress without staff intervening. There were no other witnesses that corroborated the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report and appeals process was emailed to Rventura@peoplescare.org. Based on the facility grounds inspection, LPA Rivera and LPA Burgess observed the facility to be generally clean and in good repair however, there were several noted areas of concerns. In one client bedroom, LPAs observed paint chipping on the walls and dirty walls near the client's bed and in the closet. Staff informed LPAs the client picks the walls. LPAs observed a broken outlet cover in the living room and two light bulbs out in the only lighting fixture in the bathroom near the garage. The garage door was observed to be half open, off track, bent, and inoperable. The staff secured the garage on the day of inspection. The garage door was repaired on 11/11/2021. There were multiple push pins, one needle, and one safety pin that were accessible, as well as empty food bags in client's belongings on the ground in the playroom. Staff removed these items immediately. The walls of the playroom had paint and dirt. In the backyard of the facility, LPAs observed trash on the ground, Staff and client picked up that trash during this inspection. Photos of these observations were taken on LPA Rivera's state-issued cell phone. The allegations are: The facility is dirty. The facility is in disrepair. Based on the physical evidenced, there is a preponderance of evidence that shows the facility is in violation of the California Code of Regulation, Title 22, Division 6, Section 80087(a). Therefore, the above allegations are SUBSTANTIATED. This is the second Buildings and Ground violation cited within 12 months, therefore a civil penalty in the amount of $150.00 has been issued to the facility. An exit interview was conducted, and a copy of the report and appeal process was provided to Aventura@peoplescare.org

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

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

met_with: Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
During confidential interviews LPA was informed that the client slid out of the chair while the staff was taking him down the vehicle's ramp to get him to class. To the individual, this indicated that the seat belt was not properly fastened. Additionally, a school staff member came to assist the staff, however those interviewed could not remember their name and LPA was unable to interview them. Due to inconsistent information and not being able to interview the client and other witness, LPA has found the allegation that staff mishandled client in care to be UNSUBSTANTIATED, which means that while the allegation may have occurred or is valid, there was not a preponderance of the evidence to prove that it did or did not occur. An exit interview was conducted with staff Quinisha Silva and a copy of this report and appeal rights were emailed to her with a read receipt which will serve as the record of receipt.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with satff Quinisha Silva who assisted LPA with this inspection. LPA investigated this complaint by conducting confidential interviews with the Reporting Party, three staff, and one witness on 11/24/2021 and 12/3/2021. LPA attempted to interview the client, however due to the client being non-verbal, LPA was unable to interview him. Based on confidential interviews, LPA learned that the client regularly fights being in his wheelchair and will go rigid with his limbs and slide out. LPA also learned that the client likes to be on warm surfaces, such as the asphault. The staff accused of mishandling the client denied that he did so, however admitted to struggling to get the client in the chair due to being a substitue transporter that day, as well as not having handled the client in a while, and was unexpecting of the clients growth since the last time he had seen the client. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 12/03/2021

met_with: Quinisha Silva


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Monica Roberts conducted an unannounced inspection to the above agency on 3/9/23 at 2:00 p.m. to discuss the allegation as stated. LPA Roberts met with Alecia Loyd, House Lead, and spoke by phone to Diane McGill, Administrator. LPA Roberts informed Ms. Loyd and Ms. McGill that the complaint investigation included initial inspection conducted on 1/12/23 by Monica Roberts, LPA1 and Uchenna Ajaero, LPA 2. LPA1 received documents related to C1 (see LIC 811 dated 1/12/23).Regarding the allegation that C1 obtained unexplained bruising while in care, LPA1 discovered during confidential interviews and observation that C1 displays self-harming behavior frequently throughout the day, including to the right forearm where the bruising was noted. In addition, the facility has not provided consistent 1:1 supervision as required in C1's Individual Placement Plan. This was verified by reviewing two weeks of timesheets preceding the allegation and during confidential interviews.As a result of the investigation, information obtained and interviews conducted, the allegation is unsubstantiated at this time, meaning there is not a preponderance of evidence to prove the alleged allegation did or did not occur.Exit interview was conducted with Ms. McGill. A copy of the report and appeal rights were provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Monica Roberts LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Diane McGIll, Administrator


raw_content:
Narrative:
Regarding the allegation that staff did not ensure clients medical needs were being met, statements made during interviews by 4 of 5 staff corroborated that many medical appointments were cancelled for unknown reasons. S1 stated that C2 missed 2 dental appointments and an additional court request had to be made as a result. S5 stated, "Appointments were cancelled due to scheduling issues and lack of communication." Quarterly Review of IPP corroborates that there was a lapse in medical appointments for C1. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Regarding the allegation that documentation has not been provided, based on interview, IPP- Needs and Services Plan was not provided to authorized representative during the latter part of 2022 by previous administrator. 1 staff of 5 stated that documentation requested by authorized representatives is provided if requested but, could not provide verification. 4 of 5 staff were unaware if documentation was provided. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Regarding the allegation that incontinent needs are not being met, statements made by three of five staff corroborate that facility has run out of diapers for clients and a staff had to purchase at Walmart. 2 staff state the facility has not run out. Representative of vendor who supplies the diapers stated that 122 diapers are provided a month for C1 but, noted that there were delays in deliveries in November and December 2022. Regional Center staff stated they were aware of client running out of incontinent supplies and informed facility to use P and I to purchase diapers for the client. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Continued on LIC9099C Regarding the allegation that staff ratio is not being adhered to, 3 of 5 staff state that at times the facility is out of ratio. S3 stated facility was out of ratio two times a week. LPA verified by record review of schedules that the facility was out of ratio. A report dated 09/22/2022, stated a 1:1 client was left unsupervised and was in distress. Additionally, on 03/07/2023, LPA observed only 2 staff present with four clients, 2 of which require 1:1 supervision. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. The facility is being cited for violation of California Code of Regulations, Title 22, Division 6, Chapter Personal Rights 84072 (d) to receive medical care, Personal Rights 84702 (d) (4) Communication with authorized representative, 80077.4 (b) (8)Care for Clients with Incontinence 80077.4 (b) (8) and 84065.5 (c) Staff/ Child Ratios. An exit interview was conducted, a copy of this report and appeal process was reviewed and provided to the Administrator . Regarding the allegation that staff did not ensure client's mental health needs were being met, an online appointment occurred on Zoom with psychologist on 12/28/2022 for medication refills. Two staff of five interviewed stated clients have mental health appointments but, documentation of the appointments was unable to be located by the facility. Three of five staff did not know how often clients had mental health appointments. Evidence provided does not support or disprove this allegation. 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. Exit interview was conducted with name , title and a copy of this report along with appeal rights were discussed and provided to facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 03/17/2023 at 9: AM. LPA Goldie spoke with, Diane McGil, Program Administrator (PA) to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed PA this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 12/08/2022. LPA Goldie toured the facility and interviewed two facility staff. Copies of facility documentation provided to LPA Goldie included: Client register, four client's individual personalized plan, Staff Roster, staff schedules and timecards for November and December 2022 and staff contact Information. Confidential interviews were conducted with four staff, Alta Regional Center supervisor and 2 coordinators, Behavior Consultants and Program Administrator between 12/08/2022 and 03/06/2023. 1 client interview was conducted and 2 clients were observed to be non-verbal. Records review of documents obtained was completed on 12/17/2023, 01/16/2023 and 03/02/2023. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 03/17/2023

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

met_with: Diane McGil Program Administrator


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Allegation # Facility does not provide supervision necessary to meet clients' needs Regarding the allegation that staff does not provide supervision to meet clients' needs, record review of Individual Program Plans/ Needs and Services for clients indicate 2 clients in placement require 1:1 supervision for health and safety. 6 staff of 9 staff corroborate that two staff instead of three staff are scheduled which is inadequate to meet the safety needs of the clients and provide supervision as required. Statements made during interviews include "C3 needs more supervision as he has gotten into office," "It is difficult to engage with clients as necessary due to lack of proper number of staff," and "On weekends, staff are pulled to other houses and 1 staff is left with 3 clients-one who requires 1:1 supervision." Two staff stated at times staff are on their phones. Incident report dated 01.21.2023, reports a client took a debit card from a staff's purse indicating lack of supervision. On 02/22/2023, LPA observed upon arrival one staff training online and another staff in the office and two clients unsupervised. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 ,Chapter 5 84078 (b),Responsibility for Providing Care & Supervision is being cited on the attached LIC 9099D." Allegation # Facility did not administer medications as prescribed Regarding the allegation that staff did not administer medications as prescribed, record review of incident reports indicates that on 01/26/2023, C4 did not receive AM medication as S1 forgot to provide it. Two staff members corroborate that C1 did not receive medication prescribed on 12/31/22 and 01/01/2023. The Medication Administration record verifies client did not receive PM medication on these dates. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter Personnel Requirements, is being cited on the attached LIC 9099D Continued on LIC9099C Allegation # Facility did not report incidents as required. Regarding the allegation that facility did not report incidents as required, LPA observed that incident referred to by reporting party was called in to licensing but, a 7 day follow-up written report as required was not submitted to licensing. Additionally, LPA observed there were zero incidents reported for 2022 but, 3 staff stated they communicated incidents to Administrator that should have been reported. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1 80061 (b) Reporting Requirements, is being cited on the attached LIC 9099D." Allegation # Facility did not have personal hygiene items necessary. Regarding the allegation that incontinent needs are not being met, statements made by three of five staff corroborate that facility has run out of incontinent supplies for clients and a staff had to purchase at Walmart. 2 staff state the facility has not run out. Representative of vendor who supplies the briefs stated that 122 diapers are provided a month for C1 but, noted that there were delays in deliveries in November and December 2022. Regional Center staff stated they were aware of client running out of incontinent supplies and informed facility to use P and I to purchase diapers for the client. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. This facility was previously cited for this allegation on 03/17/ Title 22, Division 6, Chapter 1 80077.4 (b) Care for Clients with Incontinent Needs and therefore, will not be re-cited. Allegation # Facility does not have enough staff. Regarding the allegation that facility does not have enough staff, 6 staff of 9 staff corroborate that there are not enough staff and ratios are not being met as 1:1 clients are in the facility. A staff stated, "7 full time staff and 1 part time staff are needed." Another staff stated, "to make sure the kids are okay, more staff are needed." One client stated 2 staff were in the home in the afternoons when all clients are home. One client said they didn't know how many staff were in the facility and two clients are non-verbal. Continued on LIC9099C LPA verified by record review of schedules that not enough staff are scheduled to meet the needs of the clients per Needs and Service Plans as two clients in home require one to one supervision for health and safety and therefore 3 staff are necessary when all clients are present in the facility. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 1 80065 (a) Personnel Requirements, is being cited on the attached LIC 9099D." Allegation # Facility is not following the complaint/grievance policy. Regarding the allegation that facility is not following the complaint/grievance policy, 5 of 8 staff state they are unaware of what the complaint/grievance policy is for clients. 1 staff stated a grievance policy exists but, I don't know if there is a box available is available for clients to submit concerns. 1 staff stated clients can call a telephone number or speak to the administrator if they have a grievance. LPA did not observe grievance policy posted in an area visible for clients as required during inspection. Record review of resident grievance policy and explanation forms are not signed by the clients that are able to sign- (2 of 4) and were completed 02/01/2023. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division Chapter 5 84072.2 (a) Complaint Procedures, is being cited on the attached LIC 9099D." An exit interview was conducted, a copy of this report and appeal process was reviewed and provided to the Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 03/27/2023 at 11: AM. LPA Goldie spoke with, Program Administrator, Diane McGil to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed facility staff this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 02/22/2023. LPA Goldie toured the facility and interviewed two facility staff. Copies of facility documentation provided to LPA Goldie included: Client register, four client's individual personalized plans, MAR sheets for 2 clients, staff schedules for four months, incident reports, invoices for personal hygiene items, and written grievance plan. Confidential interviews were conducted with nine staff, Alta Regional Center supervisor and 2 coordinators, 1 county social worker, Behavior Consultants and Program Administrator between 02/22/2023 and 03/20/2023. 2 client interviews were conducted, and 2 clients were observed to be non-verbal. Records review of documents obtained was completed on 02/28/2023 and 03/02/2023. Continued on LIC9099C. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 03/27/2023

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

met_with: Alisia Nesina DSP Diane McGil Program Administrator

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Confidential interviews were conducted with the Administrator, Lead Staff and seven staff members. Combined with reviewing time sheets against actual hours worked, it was discovered staff was at times not in proper ratio to cover two 1:1 clients in the home including 4/4/23 a.m. shift, 4/8/23 a.m. shift, and 4/14/23 a.m. shift. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that Staff do not provide adequate supervision to minors in care is substantiated meaning that the "preponderance of the evidence" standard has been met. The allegation states that Minor's medication records are not properly maintained by facility staff. Confidential interviews were conducted with the Administrator, Lead Staff and seven staff members. All staff interviewed confirmed that the medication key was kept unsecured in the staff office where an untrained staff or client could access it at any time to unlock the medication cabinet. A medication audit was conducted by LPA Roberts on 6/22/2023. During this audit, there were inconsistencies found on the client MARS including: a client medication being listed twice and therefore being double signed for, a discontinued medication remaining on the MAR and a medication listed with the wrong mg to be given. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that medication records are not properly maintained by facility staff is substantiated meaning that the "preponderance of the evidence" standard has been met. The facility was cited for violation of California Code of Regulations, Title Division 6, Chapter 5, Article Staff/Child Ratios 84065.5 (c) The facility was cited for violation of California Code of Regulations, Title Division 6, Chapter 1, Article Health Related Services 80075 (k)(1) Diane McGill, administrator authorized Tazjinae Sims, DSP to sign in her absence. A copy of this report and appeal rights was left at the facility. End of report. Confidential interviews were conducted with the Reporting Party, Administrator, Lead Staff and seven staff members. Review of the facilities refrigerators, freezers, perishable and non-perishable foods, menus and grocery receipts were conducted. An interview was also conducted with Client #1. There was at least 3 days of perishable food and a week's worth of non-perishable food present on various unannounced visits conducted on 5/5/2023, 5/15/2023, 5/18/2023, 5/26/2023, 6/6/2023, 6/14/2023 and 6/22/2023 and the food in the home matched that noted on the menu for the week. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that Minors in care are not provided proper food service and that grocery shopping is delayed days at a time leaving the fridge and cabinets almost bare is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegation states that staff are not properly trained and asked to sign for training that was not received. Confidential interviews were conducted with the Administrator, Lead Staff and seven staff members. Staff 1 through 7 reported that they were supervised and signed after training was completed. Staff #1-7 stated they were trained by multiple members of the management team. Staff 1 through 7 felt sufficiently trained for their roles. Review of training documents were conducted. Staff 1 through 7 had proper training documentation in employee files. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that staff are not properly trained is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Diane McGill, Administrator, authorized Tazjinae Sims, DSP to sign in her absence. A copy of this report and appeal rights was left at the facility. End of report.

Investigation Findings:
13On 8/4/2023 at 1:00 p.m. Licensing Program Analyst (LPA) Monica Roberts arrived at the facility to conduct an unannounced complaint inspection. LPA spoke with Diane McGill, Administrator via phone to discuss the findings of the complaint investigation and the allegations stated above. The complaint was investigated by LPA Monica Roberts. The initial 10-day complaint investigation inspection was conducted on 5/5/2023. The following documents were obtained: Current List of approved medication passers and Overnight Staff List, Medication Administration Record for the past two months, Training Procedures and check off sheets for all staff hired since 2/1/2023, Staff Schedule and Time sheets for the month of April 2023, Client IPPs, Job Description and Shift Expectations for NOC (Overnight) Staff and other relevant documents. Interviews were conducted with the Reporting Party on 5/15/2023, Client 1 on 5/9/2023, Staff 1 on 5/16/2023 and 6/14/2023, Lead Staff on 5/16/2023 and 6/14/2023, Administrator on 6/6/2023, Staff 3 and Staff 4 on 5/18/2023, Staff 5 and Staff 6 on 5/26/2023, and Staff 7 on 6/22/2023. LPA Roberts investigated the above alleged allegations. This allegation is regarding the staff not providing adequate supervision to minors in care. (Continued on LIC 9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Monica Roberts LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 08/04/2023

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

met_with: Tazjinae Sims, DSP and Diane McGill, Administrator via phone


raw_content:
Narrative:
Allegations related to C1's medical condition and attending medical appointments include C1 has had and/or needed referral(s) to specialty medical services, including a pediatric gastrointestinal (GI) doctor, podiatry, and ear, nose, and throat (ENT) doctor, that the licensee/administrator has not scheduled and/or taken C1 to. In review of the documentation obtained, there are notes indicating that C1 was referred to GI specialty services due to an elevated lab report on 8/8/24, but this was not completed. LPA Hill interviewed the administrator about this on 10/31/24, and the administrator stated that this is no longer necessary, but was unable to provide proof or documentation attesting to this. As of the date of the writing of this document, C1 has not seen this specialist. This same documentation states that C1 was to return for a follow up "in about 4 weeks" but C1 did not see this doctor again until 11/27/24. When interviewed about missing appointments or needing to reschedule appointments, the administrator states that they do not document the change in appointments but "it is written on the whiteboard". C1's parent/guardian, school, and doctor's office have communicated various concerns including but not limited to C1 being excessively sleepy, weight gain, rectal bleeding, and elevated blood levels but the facility has no documentation about how these concerns were being addressed. The facility failed to provide documentation on what is being done to manage them. In the documentation obtained, it was noted that on 8/27/24, the school reported rectal bleeding when toileting, but there is no documentation indicating that C1 was taken to a hospital or doctor contacted as a result. Other documentation obtained indicates that C1 has "gained almost 100 lbs since 3/2023" but there is documentation about the facility reaching out to a doctor for further evaluations and/or referrals for medical professionals to assist the facility in managing this. The documentation shows that the facility was advised to increase C1's exercise in the facility, but there is no documentation that this has been done. As a result of the investigation including interviews conducted, documents reviewed, and information obtained, the allegations that staff do not address C1's change in medical condition and that staff do ensure a minor attends scheduled medical appointments are SUBSTANTIATED at this time meaning the "preponderance of the evidence" standard has been met. The facility is cited for violation of California Code of Regulations, Title Division Six, regulation 80078(a) Responsibility for Providing Care and Supervision as it relates to C1's medical condition, including weight gain, elevated blood levels, and/or bleeding, and medical appointments needed including to be seen by specialty doctors as prescribed by doctors when referrals are made and this not being completed or managed. The allegation that staff are not ensuring C1 sleeps appropriately is related C1 being notably sleepy upon arrival at school and needing additional time in the mornings to sleep at school prior to engaging in the school programming. Interviews conducted with school personnel indicate that this was happening frequently but in review of documentation provided, it appears that there are notes indicating this was happening almost daily from 8/9/24 to 9/25/24. The facility's documentation notes that C1 was sleeping from 10 to 11 hours a day during this same time period without disruption. It is also noted that C1 had a medication change that could have contributed to the change(s) noted as well. There were no notes indicating that the noted sleepiness went beyond these dates provided during the investigation. As a result of the information obtained, documentation obtained, and interviews conducted, the allegation that staff are not ensuring C1 sleeps appropriately is UNSUBSTANTIATED at this time meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documents provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 1/6/25 at 12: PM and met with Diane McGill, Administrator, to discuss findings of the complaint allegations. LPA Hill informed Ms. McGill that the investigation included an initial inspection to the facility on 9/13/24, where the facility was toured and appeared to be in compliance. LPA Hill conducted subsequent inspections at the facility on 10/31/24 and 12/5/24 for the purposes of obtaining additional documentation. In addition, LPA Hill conducted interviews with Alta California Regional Center Service Coordinator, parent/guardian of C1 (see LIC811 dated 1/6/25), facility administrator, and C1's educational staff from 9/13/24 to 1/3/25. C1 is nonverbal and unable to be interviewed as part of this investigation. LPA Hill obtained and reviewed documentation from C1's school, Regional Center Service Coordinator, Behavior Consultant, and the facility for consideration in the findings for this complaint investigation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 01/06/2025

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

met_with: Diane McGill, Administrator


raw_content:
Narrative:
During the investigation LPA obtained consistent statements during the investigation process about an Administrator intimidating a youth in care. Five of five interviews confirmed that the Administrator inappropriately interviewed youth in their room alone, with the door closed, and no other staff as a witness. Additionally, the Administrator admitted to the allegation. Based on LPAs observations, records review, and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (CCR) are being cited on the attached LIC 9099D. An exit interview was conducted, and Appeal Rights were discussed with Melenaite Delmar, Administrator. A copy of this report and Appeal Rights were left at the facility. During the investigation LPA obtained inconsistent statements during the investigation process about Administrator preventing staff from entering the office. Three of six interviews confirmed Administrator does allow staff in the office. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur therefore the allegation is unsubstantiated. An exit interview was conducted, and Appeal Rights were discussed with Melenaite Delmar, Administrator. A copy of this report and Appeal Rights were left at the facility.

Investigation Findings:
13On October 22, 2025, Licensing Program Analyst (LPA) Orlando Areizaga conducted an unannounced visit to the above agency to deliver the findings of a complaint investigation. LPA met with Melenaite Delmar, Administrator and was granted entry. Prior to the meeting, LPA initiated the complaint investigation on September 11, 2025. No deficiencies were cited during that inspection. LPA requested the following documents LIC 500, LIC 9020, Staff roster, staff contact information, client incident reports for the last 5 months, clients' needs and services plans, disciplinary log for staff involved for the last 5 months, and case notes for each youth for the last 5 months. 8 confidential interviews and 1 observation were conducted between September 2025 and October 2025 by LPA Areizaga. Lastly, LPA could not confirm the allegations with Staff 3 (S3) after multiple failed attempts to contact. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Orlando Areizaga LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 10/22/2025

met_with: Melenaite Delmar, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by the Licensing Program Analysts (LPA) Ignacia Villapudua-Soto on 04/22/21 at 4: PM via Facetime due to Covid19 pandemic. LPA met with Administrator, Rodina Ventura. LPA discussed with Administrators an incident report submitted to Community Care Licensing (CCL) on April 22, 2021 concerning an incident dated 4/15/2021 where Administrator and staff was transporting C1 to pick up another client from a home visit. Administrator picked up C2 and brought her into the van. C2 entered the van and accidentally spit on C1. C1 become upset and aggressive with staff and then ran off. (See confidential names list dated 4/22/21) Staff followed C1 into a hospital waiting room that was near by. Staff attempted to de-escalate C1. The security guards and the hospital staff tried to de-escalate the client but C1 was out of control. The hospital staff brought out a gurney and admitted C1 to the hospital at 8: PM. Due to C1 being so assaultive and uncontrollable, the nurses administered an intramuscular shot with sedative medications to calm C1 down. The Administrator stayed with client during her stay while she recuperated and to see if the client was going to remain at the hospital and for support. The Doctor, however, discharged C1 from the hospital because C1 did not need to stay at the hospital any longer and was discharged at PM. The nurse and Administrator jointly attempted to wake up client. C1 slowly started yelling and screaming again. The Administrator and nurse attempted to de-escalate C1 but she continued to be aggressive and assaultive. The nurses, Administrator and staff jointly put C1 in the facility van. The administrator sat in the van to transport (the care was not turned on) the client but C1 continued her aggression. The staff was sitting by client in the van also tried to de-escalate C1. C1 unbuckled her seat belt and started to attack Administrator and staff. The security officers told the staff to get out of the van due to C1's unsafe behaviors making it unsafe to drive with C1. C1 stayed in the van throwing stuff at staff and security guards. The Woodland police was called to assist with the unsafe behaviors of client 1. The police wanted to bring C1 back to the hospital but the hospital staff stated that C1 did not meet the 51/50 hold and could not stay at the hospital. The staff continue to try to de-escalate the client. The Police officer told client that if she did not take control of herself they would take her to Juvenile Hall or they could transport her back to facility if she behaved. C1 agreed to be transported by Woodland police to the facility in a safe manner. Once the client arrived at the facility the staff continued to talk to client. C1 was given a snack and she went to bed without any issues. The administrator stated she will conduct additional training for Crisis training on de-escalation strategies. Administrator has a safety plan in place. No deficiencies were cited at this time. Exit interview was conducted with Administrator. A copy of this report was emailed to Administrator for signature.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by the Licensing Program Analysts (LPA) Ignacia Villapudua-Soto on 04/26/21 at 3:30: PM via Facetime due to Covid19 pandemic. LPA met with Administrator, Rodina Ventura. LPA discussed with Administrators an incident report submitted to Community Care Licensing (CCL) on 04/26/21 regarding an incident dated 04/21/21 where C1 was feeling agitated because she wanted to go home and did not want to be in a group. The staff took her for a walk to talk and relieve some tension. While on the walk, the client become even more agitated and escalated. C1 picked up sticks and started to wave the sticks at staff. Two staff members maintained distance not to get hit by sticks. C1 start yelling inappropriate cuss words to staff. Staff attempted to de-escalate model and asked C1 to do breathing skills to help C1 relax C1. As other minors were trying to walk by on the sidewalk, C1 was swinging the sticks at their direction intending to hit on of them but the minors were able to walk away safely. Sacramento Sheriff was driving by and he witnessed C1's actions and pulled over. Police officer recognized C1 and tried to de-escalate her and talk to her. C1 started to yell and was cussing at the officer. C1 tried to go onto the street with oncoming cars. Due to C1's unsafe behavior, the officer tried to assist C1 and escort out safely out of the street. C1 started to assault the officer. The officer handcuffed C1 and put her in the back of the police car. C1 started to kick the glass windows attempting the break the glass of the police car. The Officer removed C1 from the Police car and sat her in the sidewalk. Police officer called for assistance and help from the fire department to get an ambulance to transport C1 to the hospital for a 51/50 hold. The client was transported to the hospital by Sac Metro paramedics. The hospital has been in contact with Administrator where they will place C1 in the Mental Health facility for Psychiatric evaluation. Administrator is working with Mental Health and requesting 1:1 support from her County Social Worker. Administrator is asking for additional assistance from the Regional Center and other entities. No deficiencies were cited at this time. Exit interview was conducted with Administrator. A copy of this report was emailed to Administrator for signature.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced required annual inspection at the facility and met with staff Quinisha Silva (S1) who assisted with the inspection. Administrator Rodina Ventura arrived during this visit and assisted LPA as well. LPA and S1 conducted a walk-through of the facility. LPA observed four bedrooms, two living rooms, one kitchen, one half-kitchen, four bathrooms, the backyard area, the garage, and the staff office. LPA observed the bedrooms to be acceptably clean and equipped with the proper items. LPA observed the carbon monoxide detectors to be non-working/broken. The facility replaced them during this inspection. LPA observed the first aid kit to be missing scissors, tweezers, adhesive tape, and antiseptic solution. The water temperature measured at 113.1 degrees Fahrenheit, which is within the required range of 105 to 120 degrees Fahrenheit. LPA observed there to be an adequate amount of food, both perishable and non-perishable, meeting regulations. LPA observed the facility to be clean and free of hazards or insects. LPA did not observe complaint/grievance procedures posted, however Administrator posted it as required during this inspection. There was a hot water warning sign missing from near the Keurig machine, and Administrator corrected this during the inspection. LPA reviewed the fire clearance, license, program statement sections, and three client records. Board of Director Meeting Minutes provided were inadequate as they were only a list of topics covered with no further discussion details. LPA also reviewed operational requirements, and the disaster preparedness plan. The emergency disaster and mass casualty plan were missing complete information. There were no written authorizations from parents/guardians for psychotropic medications, however, Administrator corrected this during this inspection. LPA reviewed client medications and found that the Medication Administration Records (MARs) were inadequate for the psychotropic medication requirements and were missing some information, additionally, multiple psychotropic medications were listed together on one sheet. Additionally, there was no mention of money handling capabilities and restrictions in clients' Needs and Services Plans. LPA was unable to complete this inspection on this date and will return on another date to complete it. On this date, one Type B citation was issued for non-working/broken carbon monoxide detectors in the facility. Advisory notes were issued for the issues described. An exit interview was conducted with Administrator and a copy of this report was emailed to her with a read receipt which will serve as the record of receipt.

met_with: Quinisha Silva & Rodina Ventura


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual continuation inspection at the facility and met with Administrator Rodina Ventura who assisted with this inspection. As LPA was leaving the facility yesterday on 12/22/ LPA observed one client (C1) who requires 1:1 supervision not being supervised, leading to him falling through a plastic tote box. The client was not injured. The staff (S1) was on the couch on her phone, with her back turned to the client, and the client was out of sight behind a partial wall. This is an immediate health, safety, or personal rights risk to clients in care and on this date the facility is being cited for a violation of the California Code of Regulations, Title 22, Division 6, Chapter 1, Section 80078(a), Responsibility for Providing Care and Supervision. LPA found on 12/22/2021 that the facility is not issuing clients allowance as required. During LPA's assessment and review of the money-on-hand for the clients and records, there were discrepancies in the written balances and the actual money on hand. Additionally the record/logs for transactions were out of date, incorrect, and for one client (C2), non-existent. LPA continued the annual inspection started on 12/22/2021 and reviewed seven staff files and the Administrator's file. LPA found that all staff and Administrator had their health screening, TB test, CPR/First Aid training, drivers licenses, and clearances as required. LPA found that one staff was not associated to this facility, however is a staff of this facility. LPA observed that there were no job descriptions for staff or administrator in the files, and that there is a staff schedule as required, however it did not have dates or position titles on it. LPA did not observe any performance evaluations in any staff files. LPA found that there are no facility managers employed at the facility as required and no facility-manager-specific training as required. LPA found one staff (S3) to be out of compliance with training hours, with only 13.25. Due to the staff being on leave, S3's online personnel record was inaccessible to Administrator to find any additional training for S3. On this date the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Sections 80078(a), 80019(e)(2), 84077(a)(2), 84065(j)(1)(A), and 84065(d). LPA also issued advisory notes for other issues mentioned. An exit interview was conducted with Administrator and a copy report and appeal rights were emailed to her with a read receipt which will serve as the record of receipt.

Deficiencies:
84065(d): (d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present

met_with: Rodina Ventura


summary: Facility Evaluation

raw_content:
Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Hillary Hall on March 2, 2022 at AM. During the inspection, LPA Hall met with Rodina Ventura, Administrator and inspected the facility inside and out. LPA reviewed One client file on site at the facility. LPA reviewed Two staff personnel files on site at the facility. LPA reviewed One client's psychotropic medications and medication records. Three clients reside at the facility but only one is a foster care dependent. LPA interviewed Two staff on site. LPA did not interview the client due to the client being non-verbal. LPA conducted exit interview with Rodina Ventura, Administrator. LPA provided a signed copy of this LIC 809 to the Administrator upon completion. No deficiencies are being cited at this time.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/18/22, at 9: AM,, Licensing Program Analysts (LPA's), Connie Goldie and Uchenna Ajaero, met with Facility Manager (FM) Quinisha Silva to conduct an unannounced Annual/ Required inspection of a single story, four bedroom, 3 bath home. At 9: AM, Staff Lixie Ceballos greeted LPA's Goldie and Ajaero and shared that Program Administrator Rodina Ventura is no longer on staff but, FM Silva was present. FM Silva stated that the current census was four clients. An Entrance Checklist was provided to the FM. LPA's Goldie and Ajaero conducted the physical plant inspection with FM Silva. The tour began at 10: AM at the front door of the home. LPA's observed license and Foster Youth Rights poster.( LPA Ajaero will provide updated copy of Foster Right's poster on day 2 of Annual Inspection.) LPA's observed a spacious sitting room with adequate seating and lighting. We proceeded to the hallway, where LPA's observed closet containing individual containers for client's hygiene products.The thermostat read 75 degrees within compliant range.The tour moved to the laundry room where functional washer and dryer were running. LPA's observed cleaning supplies to be safely stored and inaccessible to clients LPA's observed four individual bedrooms with clean linens and a closet space. Each of these bedrooms had dressers and night stands with drawers. One of the dressers in bedroom #2 had a broken drawer as a result of behavior by client. We then entered garage where additional paper products, hygiene supplies and gloves were stored in cabinetry. The van was observed to have front end damage. LPA Ajaero asked what happened. FM stated an accident occurred in February and driver, no longer employed, left the scene. FM stated Program Administrator Rodina Ventura did not report it so the van has not been repaired. The tour continued to the kitchen where FM opened all cabinets, perishable food for two days and non-perishable food for five days, menu, adequate table ware and clean sink and stove were observed. Fire extinguisher pin in place, smoke detector and fire alarms tested and compliant. Two bathrooms were observed to have soap and paper towels. Medication was adequately stored in locked cabinet in locked office. Outside LPA's observed pool to be safely secured , a basketball court and an area free of debris. All windows and screens were in good condition. Two Title Violations , 1 type B are being issued today. Additionally, 3 technical advisories and 2 technical violations are also being issued. These are not deficiencies. An exit interview was conducted with FM Quinesha Silva at 09: AM . A copy of this report along with appeal rights were discussed and provided.

met_with: Quinesha Silva


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 11/21/2022, at 9: AM, Licensing Program Analyst"s (LPA) Connie Goldie and Uchenna Ajaero met with Facility Manager (FM) Quinesha Silva to continue unannounced/required Annual inspection. FM Silva stated that three staff and three clients are currently in the facility. One client is on a home visit. Care Tool domains Client Records and Operational Requirements were completed during today's inspection. LPA's Goldie and Ajaero conducted five staff interviews, S1, S2, S3, S4 and FM and 2 client interviews C2 and C3. LPA's reviewed 4 client files. The following Title 22 citations are being cited today- Type B violations. Civil penalties were assessed for one repeat violation. Additionally, 3 technical violations and 2 technical advisories are being given. These are not deficiencies. LPA's conducted exit interview with Facility Manager Silva at 6: PM. A copy of this report along with appeal rights was left at the facility

Deficiencies:
84063(a): Accountability

(a) The board of directors shall be active in ensuring accountability, and shall perform, at a minimum, the following duties


summary: Facility Evaluation

raw_content:
Narrative:
On 11/22/2022, at 1: PM, Licensing Program Analyst"s (LPA) Connie Goldie and Uchenna Ajaero met with Program Administrator,(PA), Diane McGill and District Manager, (DM), Kourtney Hamilton to continue unannounced/required Annual inspection. DM stated that three additional staff and three clients are currently in the facility. One client is on a home visit. Care Tool domains Disaster Preparedness, Emergency Intervention Plan and Staffing Records, were completed during today's inspection. DM Hamilton provided $5 to each client for allowance and implemented today to stop Civil Penalty assessments. The following Title 22 citations are being cited today- Type A violation. Civil penalties were assessed for one repeat violation. Additionally, 1 technical violation and 1 technical advisory are being given. These are not deficiencies. Annual inspection is completed for this year. LPA's conducted exit interview with PA McGill and DM Hamiliton at 4: PM. A copy of this report along with appeal rights was left at the facility

met_with: Program Administrator Diane McGill District Manager Kourtney Hamilton


summary: Facility Evaluation

raw_content:
Narrative:
On 03/01/2023, Licensing Program Analyst, (LPA) Connie Goldie conducted an unannounced case management inspection to follow up on issues identified during annual inspection conducted 11/18/2022- 11/21/2022. LPA Goldie interviewed two staff for this case management. Further investigation is required. Exit interview at 6: PM.

met_with: Program Administrator Diane McGil


summary: Facility Evaluation

raw_content:
Narrative:
On 03/17/2023, Licensing Program Analysts, (LPA's) Connie Goldie and Monica Roberts made an unannounced case management visit for the purpose of following up on deficiencies that were cited during Annual inspection that occurred on November 18, 2022- November 22, 2022. LPA's met with Diane McGil, Program Administrator (PA) and Abe Avila, Regional Director (RD) who assisted with today's inspection. LPA's reviewed LIC500. LPA's reviewed 4 client facility files. LPA's observed schedule posted. LPA's reviewed Board Minutes. LPA's observed MAR sheets. LPA's observed Personal and Incidentals (P & I's ) for 4 clients. LPA's observed Restraint Logs LPA's conducted a walk through of the facility inside and out. LPA's observed schedule posted included additional staff not on LIC500 and determined one staff on the schedule for 03/04/2023 was not associated to facility. This is a repeat violation within 12 months as a citation was issued on 11/22/2022. LPA Goldie viewed Board Minutes from previous meeting held in December 2022. It was observed that the Annual held 11/18/2022- 11/22/2022 was not discussed during the meeting. Additionally, 5 crisis events were notated on the Minutes agenda and zero SIR's were received by licensing. RD checked for notation regarding crisis events and was unable to locate any information. This indicates that incidents were not reported as required. LPA's reviewed medication MAR sheets and observed that controlled medications are still not separated to a PMAR sheet. PA McGil provided status update for completion as a plan of correction (POC) is due by 03/24/2023. PA stated the controlled medications will be placed on PMAR's as required on 03/21/2023 by facility nurse prior to POC due date. Review of clients facility files indicate LIC601's have been put into files stating who can and cannot have visitation with clients. Continued on LIC809C LPA verified 3 of 4 clients do not have a dentist. PA stated she was actively searching for a dentist who would take special needs kids. During review of P & I's, LPA identified allowance was not provided to 4/4 clients in January 2023 and February 2023. This is a repeat violation. RD stated that the allowance issue is now clear and going forward this will not be an issue. Restraint Log was observed to be implemented and updated as required. LPA Goldie conducted a walk through of the home at 2: PM. PA McGil assisted LPA Goldie with the tour of the single story 4 bedroom, 4 bathroom home. LPA observed new bed in bedroom 3 and new mattress in bedroom 2 as well as new mattress covers on all 4 mattresses. In the kitchen, LPA observed 2 days of perishables and five days of non-perishables in the cupboards with additional snacks in the pantry. Medication, chemicals and sharps were observed to be inaccessible. Bathrooms had sufficient supply of soap and paper towels. Living areas were well lit and had sufficient seating including new sofas and chairs and a large bean bag. Dining area was observed to have a table and chairs in good repair. The outside area was free of debris. A basketball court, enclosed pool and garden area were observed. No deficiencies were observed during facility walk through. *Technical issues occurred with LPA Goldie's laptop, therefore, this report along with deficiencies and civil penalties were unable to be provided on date of inspection. Additionally report could not be provided. LPA Goldie will return to facility on 03/21/2023 to deliver report, citations and civil penalties. LPA Goldie met with Alecia Loyd on 03/21/2023 to obtain signature for this report.

met_with: Diane McGil Program Administrator Abe Avila Regional Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced Plan of Correction inspection on 4/20/23 at 9: AM. Upon arrival to facility, LPA observed home empty. LPA called Program Administrator, PA, Diane McGil who stated staff took client for a doctor's appointment. PA stated staff would arrive shortly and she would arrive by AM. Lead, Alecia Loyd arrived at 10: AM. LPA Goldie toured the facility with Lead Loyd inside and out. LPA observed a four bedroom, two bath single story home. The kitchen had required non-perishable and perishable quantities of food. Living room and dining area had sufficient seating and egress areas were clear. LPA observed that sensory room now has a fusball table and new outside games that were recently purchased. Outside areas were observed to be free of debris. LPA Goldie went through citations with Program Administrator McGil that are outstanding to determine what has been completed. LPA identified that all overdue plan of corrections have been cleared. Only two plan of corrections due on 04/27/2023 still require completion. Exit interview was conducted with Ms. McGill and documents were provided at the conclusion of the inspection. No additional citations were issued today.

met_with: Alecia Loyd Lead Diane McGil Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 06/13/2023,at 1: PM, Licensing Program Analyst, (LPA), Connie Goldie made an unannounced case management visit to follow up on the Non-Compliance plan, (NCCP) provided to facility during Non-Compliance Conference meeting held on 05/02/2023. LPA Goldie arrived at 01: PM and staff were away with two clients. At 01: PM, S2 greeted me at the door and stated S1 was parking van and would be available momentarily. Two clients were present. At 1: PM, two additional clients returned home. Ratio observed to be 2 staff to 4 clients. Administrator stated Needs and Service plans for C1 are being amended. Administrator provided documentation of this request. LPA Goldie conducted walk through of facility inside and out with the assistance of S1. LPA observed bedroom 2 missing dresser. Administrator stated replacement was ordered on 06/01/2023 and provided documentation. Additionally, documentation provided indicates sofa for family room has been ordered due to rip on seating area. LPA observed 4 bathrooms to have soap and towels available. Water temperature measured at 116 degrees within compliant range. Bathroom 4 has a inoperable toilet currently which broke this morning. A work order has been placed. Kitchen has 2 days of perishables and 5 days of non-perishables. Outside, LPA observed pool available for C2 along with trampoline, basketball court and in ground pool secured. Backyard was free of debris. LPA reviewed training documentation and observed all topics established on NCC plan to be covered. LPA observed sign-in sheets and assessments and retained copies of documentation. LPA interviewed 5 staff. LPA observed all clients during visit. Verbal client unavailable to interview as he left for a visit. No deficiencies were cited during today's inspection. A copy of report was provided and discussed with Administrator along with appeal rights.

met_with: Alecia Loyd Lead Facility Manager Diane McGill Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 09/29/2023, at 9: AM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to conduct an Annual/required inspection. LPA Goldie was greeted at the door by Lixie Ceballos, Direct Care Staff, (S1).S1 stated she was only staff present and the 3 clients were at school. S1 contacted Diane McGill, Program Administrator, (PA) who stated she would be at facility in 15 minutes. Upon arrival, LPA provided Entrance Checklist to PA McGill who assisted LPA with the inspection. LPA toured facility with S1 and observed a 4 bedroom, 3 bath single story home with a spacious living room and family room providing adequate seating for clients/staff. The temperature was observed to be a comfortable 70 degrees. All bedrooms had required furniture per regulation and were decorated per individual taste of client. LPA observed kitchen to have a pantry with 5 days of non-perishables and refrigerator/freezer with 2 days of perishables. Refrigerator temperature reads 40 degrees and is compliant with regulation. Dining area has a large dining table with seating for 6 . Sensory room has additional area for activities. LPA observed soap and towels in all bathrooms. The water temperature was observed to be 106 degrees which is compliant. LPA observed hygiene projects to be available to clients. LPA observed phone available for client use to be portable. LPA observed two sheds in the backyard, both secured. Equipment was observed to be available for clients to participate in activities outside including trampoline, vegetable garden, basketball court and corn hole in addition to the pool. Backyard was clear of debris. LPA Goldie conducted 2 staff interviews. CARE Tool components completed during todays inspection include: Physical Plant, Operations, DIsaster Preparedness and Emergency Intervention Plan. Continued on LIC809C No deficiencies were issued during inspection. A second inspection will be needed to complete Annual inspection. LPA Goldie conducted an exit interview with Ms McGill and provided a copy of this report along with appeal rights.

met_with: Program Administrator Diane McGill


summary: Facility Evaluation

raw_content:
Narrative:
On 09/29/2023, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced visit to facility to conduct Annual/required inspection. LPA Goldie was unable to print LIC809 for inspection completed between 09: AM- 02: PM due to technical issues. No citations were issued during inspection and LPA will provide reports for Annual/Required day 1 inspection when second day of Annual is completed.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/03/2023, at 10: AM, Licensing Program Analyst, (LPA), Connie Goldie made an unannounced visit to continue Annual/ Required inspection. LPA was greeted at the door by Staff, Alecia Loyd. Ms Loyd stated 3 additional staff are present and the clients are at school. Program Administrator, Diane McGill assisted with the inspection. LPA conducted record review of 4 staff files and 3 client files. LPA conducted medication record review. LPA interviewed two staff and 1 client.(Two clients are non-verbal.) No deficiencies were observed during Annual/Required inspection. LPA Goldie conducted an exit interview with Ms McGill and provided a copy of this report along with appeal rights.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/15/2024 at 3: PM, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced case management inspection to conduct a staff interview. This interview was not pertaining to operation of this facility. Inspection ended at 03: PM. A copy of this report was left with Ms. McGill

met_with: Diane McGill


summary: Facility Evaluation

raw_content:
Narrative:
At 04:00 pm on 02/14/2024, Licensing Program Analyst (LPA) Connie Goldie made an unannounced Case Management - Incident inspection to the facility listed above. The reason for the inspection is to review an incident that took place on 02/02/2024 and was submitted to the Department on 02/05/2024. LPA Goldie met with Diane McGill Program Administrator who helped facilitate the inspection. LPA discussed Incident that took place on 02/02/2024 and was received by the Department on 02/05/2024 where C1 was observed to have an unexplained injury on left thigh. Administrator confirmed that C1 was taken to urgent care on 02/03/2024 and released with direction to apply ice and monitor. LPA requested photo of bruise identified. medical documentation received from urgent care, and referral to Hematologist that was requested by C1's physician as a result of annual physical on 01/22/2024. At this time, further review is needed for this Case Management. An exit interview was conducted and a copy of this report was left at the facility.

met_with: Diane McGill Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 03/13/2024,at 2: PM, Licensing Program Analyst, (LPA), Connie Goldie and Licensing Program Manager (LPM) Jodean Hall attempted to make an unannounced case management visit to follow up on the Non-Compliance plan, (NCCP) provided to facility during Non-Compliance Conference meeting held on 05/09/2023. LPA Goldie and LPM Hall arrived at 02: PM. The Program Administrator was preparing to begin a large meeting with staff and Alta Regional Center staff. We stated we would return another day.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/08/2024, at 2: PM, Regional Manager, Margo Castaneda, Licensing Program Manager (LPM) Jodean Hall, Licensing Program Analysts' (LPA's) Connie Goldie, and Alyssa Burgess conducted a Non-Compliance Review Meeting via Teams. Present from Peoples Care is: John O'Brien, NorCal District Manager, Michelle Mainez, Chief Operating Officer, Diane McGill, Program Administrator, and Quinisha Silva, Program Administrator. Present from Alta Regional Center is: Toby Golden, Client Services Manager. The purpose of the office meeting is to review the current status of Non-Compliance plan. The following NCC primary areas of concern were reviewed: supervision, staff to child ratio, training, reporting requirements, vape pen and board accountability. It was acknowledged that Peoples Care Quality Assurance created and implemented a training program and have continued to conduct ongoing training as requested. Incident reporting has increased. The compliance for each location: People's Care Shawmutt, People's Care Kenneth, and People's Care Pleides was reviewed for the time period of May 2023- May 2024. The following current existing concerns were discussed: staffing to meet the needs of clients in care, not utilizing the emergency intervention plan as identified in facility's plan of operation when required and board accountability. Based on record reviews, the Shawmutt and Pleides locations have not had one complaint opened in the last 12 months and the citations issued have decreased. As a result, these locations will be removed from the non-compliance plan. The Kenneth location has had increased complaints and increased citations and will remain on the NCC for an additional six months. Increased oversight will remain in effect through 11/08/2024. Continued on LIC809C The Department requests a revision of the Emergency Intervention plan be submitted within thirty days with clear directives on each of the different techniques and when they will be utilized along with the verification that staff have been trained on the use of the techniques outlined based on defined behaviors. An Administrator Exception Request needs to be submitted to the Department immediately. A copy of this report was provided via email to John O'Brien, District Manager for signature.

met_with: John O'Brien District Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Connie Goldie and Milchelle Silvas made an unannounced annual inspection at the facility and met with Staff (S1) Jessica Beckel, Facility Manager (FM) and Diane McGill, Administrator, (PA) who assisted with the inspection. LPAs conducted a walk-through of the facility and observed: Four client bedrooms, one dining area, two living rooms, four bathrooms, the garage, the kitchen, the staff office, the backyard, and the front yard. One passageway leading out from the garage was observed to be blocked. A staff cleared the passageway making it accessible during the inspection. The water temperature measured 107 degrees Fahrenheit in bathroom #1 and the kitchen which is between the 105-120 degrees as required. There was an adequate amount of perishable and non-perishable foods, which were stored correctly. One of the cabinet doors in the kitchen was broken. A work order is placed to have this repaired by 11/27/2024. There was a carbon monoxide detector in the house which was operable, and smoke detectors were observed in all bedrooms and living rooms.The first aid kit was incomplete as the tweezers, the antiseptic wipes, the manual and thermometer were missing. The items have been ordered and are expected to arrive by 11/27/2024. The clients' medications were observed to be locked as required. The emergency disaster plan posted in the office is current and staff assigned to tasks are all currently employed. LPA received an updated LIC500, LIC610C, and LIC 9020. The LIC500 document was compared with Guardian roster and all staff are background check cleared. The facility is being cited for three California Code of Regulations, Title 22 deficiencies. See LIC809D pages. Two technical violations were issued. These are not deficiencies. An exit interview was conducted with Diane McGill, Administrator and a copy of this report along with appeal rights were discussed and provided.

met_with: Jessica Beckel Facility Manager Diane McGill Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/26/2024, at 10: AM, Licensing Program Analyst, (LPA) Connie Goldie met with Program Administrator (PA) Diane McGill to continue unannounced/required Annual inspection. PA stated that three staff and four clients are currently in the facility. Care Tool domain Client records was completed during today's inspection. LPA Goldie conducted 3 staff interviews, S1, S2, and S3 and 3 client interviews C2, C3 and C4. C1 declined to be interviewed. LPA reviewed 4 client files. No Title 22 citations are being cited today. Two technical violations are being given. These are not deficiencies. LPA conducted exit interview with Diane McGill, Administrator at 3: PM. A copy of this report along with appeal rights were provided to facility staff.


summary: Facility Evaluation

raw_content:
Narrative:
On September 11, 2025, at approximately 9: AM, Licensing Program Analyst (LPA) Orlando Areizaga, made an unannounced visit to the above facility with the purpose of conducting a follow up visit regarding an incident that was reported to the department on September 3, 2025, involving potential physical abuse. LPA Areizaga met with, Melenaite Delmar, Interim Administrator. This case management is to remain open. Exit interview was conducted with the licensee, this report is created to document that further investigation is needed, and a copy of this report was left at the facility.

met_with: Melenaite Delmar,Interim Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/19/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this Group Home to start the Required/Annual Inspection. LPA met with Quality Support Specialist Gina Renteria and Administrator Melanaite Delmar who facilitated a tour of the interior and exterior areas of the facility's physical plant. The records review of the clients' files were started. More time is required to complete the Required/Annual Inspection. A copy of this report is being provided to the facility.

met_with: Melanaite Delmar


summary: Facility Evaluation

raw_content:
Narrative:
On September 26, 2025, at approximately 11: AM, Licensing Program Analyst (LPA) Orlando Areizaga, made an unannounced visit to the above facility with the purpose of conducting a case management, deficiencies visit. LPA Areizaga met with Administrator in Training, Melenaite Delmar who granted LPA access to the facility. A tour of the facility was conducted. LPA observed a hole in client bedroom 2's wall. A maintenance requests was not submitted and no report was submitted to listening. On September 11, 2025, LPA initiated a 10-day complaint investigation. During the investigation LPA requested the following documentation LIC 500, LIC 9020, Staff roster, staff contact information, client incident reports for the last 5 months, clients needs and services plans, disciplinary log for staff involved for the last 5 months, and case notes for each youth for the last 5 months. It was noted by 5: PM on September 11, 2025 that the above agency did not submit the documentation in a timely manner. It was also noted that once LPA received the requested documentation that the clients needs and services plans were not completed properly. LPA observed outdated documents with missing sections. LPA is citing the following regulations 84068.2(b)(6) Needs and Services Plans, 80070(d) Client Records, and 80087(a) Building and Grounds on the attached LIC 809D. LPA is also issuing a LIC Technical Violation for Reporting. An exit interview conducted and a copy of this report was left with Administrator in Training, Melenaite Delmar.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAsJean Stidman and Sarina Buchannan on 11/25/25 at 9:45am This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Stidman and Buchannan met with Emilio Saucedo, Administrator and inspected the facility inside and out. LPAs reviewed four of staff personnel files on site at the facility. LPAs interviewed five staff on site to discuss the facilities policies and procedures of operation. LPAs did not interview one child currently prescribed psychotropic medication nor review their file as they are a private placement. LPA provided a copy of this licensing report to Emilio Saucedo, Administrator. During the inspection the LPA observed deficiencies (see attached 809D), plan of corrections were discussed and appeal rights were provided. LPA provided a copy of this licensing report to Emilio Saucedo, Administrator.

met_with: Emilio Saucedo, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Alyssa Burgess and Yuvicela Diaz made an unannounced case management inspection at the facility and met with Shakila Brown, Facility Manager (DSPII), and Steve Brown, staff (DSPI), who assisted with the inspection. LPAs conducted a walkthrough of the facility, led in part by DSPII, and observed the following: cut lettuce and sliced tomatoes were stored exposed in the refrigerator, DSPII disposed of them; in one client's bedroom, the pillow was dirty; in another client's room, there was written slurs on the frame of the closet, holes near the bottom of the wall, and dry wall/paint chips throughout the room from the damage; the bathroom sink had a layer of thick dried out toothpaste in it, and overall the bathroom was dirty; in one client's room, there was no bedsheet, and the mattress was dirty, as well as the pillow, with stains and debris; the playroom was dirty and messy with garbage, paint (empty bottles and on walls), glitter everywhere, toys strewn on the floor with the garbage, and a sewing machine with needle exposed. LPAs also observed that the medication cabinet was unlocked and accessible. Photos of these observations were taken on LPA Diaz's state-issued cell phone. On this date, the facility is being cited for a violation of the California Code of Regulation, Title 22, Division 6, Section 80087(a). The facility was also issued two Technical Violation Advisory Notes, which are not citations. An exit interview was conducted with DSPII, and a copy of this report along with appeal rights will be emailed to her with a read receipt, which will serve as the record of receipt.

met_with: Steve Brown, Shakila Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 12/08/2022, Licensing Program Analyst, LPA, Connie Goldie made an unannounced visit to amend report dated 11/22/2022 and met with Program Administrator (PA) Diane McGill. This is a revision to Annual Required Report dated 11/22/2022. LPA Goldie incorrectly cited and assessed civil penalty on LIC421FC for Title 22 citation 80019(e)(2). The previous civil penalty will not be assessed. Today, the Title 22 deficiency 80019 (e)(2) is being cited along with correct civil penalty LIC BG. The penalty assessed is for S1, S2 and S3 who were not transferred to correct facility. LPA Goldie conducted exit interview at 4: PM with PA McGill. A copy of the report along with appeal rights were discussed and provided to facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/26/2023, Licensing Program Analyst, LPA, Connie Goldie made an unannounced case management visit and met with Diane McGill, Program Administrator PA who assisted with the visit. PA stated three staff and 4 clients were present in the home. LPA toured facility with staff Alecia Loyd at 4: PM. LPA Goldie observed a single story four bedroom, two bath home. LPA observed a laundry room with functioning washer and dryer. In the kitchen, perishable food and non-perishable food was adequate, home was a comfortable temperature and outdoors was observed to be free of debris. LPA observed an unlocked pool gate. PA stated that pool maintenance person had serviced the pool at 2: PM and must have left gate unsecured. LPA Goldie requested contact information for three staff members. LPA interviewed one client. One Title 22 deficiency was cited. Building and Grounds 80087 (e) (1). Exit interview was conducted with staff Makeiva Williams at 6: PM . A copy of the report was left at the facility along with appeal rights..


summary: Facility Evaluation

raw_content:
Narrative:
On 2/24/ Licensing Program Analysts (LPAs) Jean Stidman and Misty Valencia met with Diane McGill Administrator for the purpose of a case management inspection. LPAs observed the facility does not have enough supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days on the premises. Facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 5, Article 06 regulation 84076(c)(1) Food Service. A copy of this report was reviewed with Diane McGill Administrator. A copy of this report and appeal rights were given to Diane McGill Administrator.

met_with: Diane McGill Administrator