raw_content:
Narrative:
Specifically, it was reported the clients are left waiting for hours before being seen by the medical department. It was reported it takes hours or days for the youth to be attended to when they are experiencing distress. It was reported that the case management department is not providing the youth with weekly phone calls and not communicating with the youth on when they will be leaving the facility. It was reported that client bathrooms and bedrooms have a bad smell and bedding is never changed. Additionally, it was reported that the youth are left unsupervised, going in and out of the facility, and grabbing knives from the kitchen to cook for themselves. Confidential interviews indicated clients are attended by the medical team onsite and staff can administer over the counter medication. Confidential interviews indicated staff contact the on call medical coordinator after hours if a client is having any kind of discomfort and clients are followed up with the next day. Confidential interviews indicated there is a phone schedule. Confidential interviews indicated clients can refuse phone calls. Confidential interviews indicated clients were making phone calls outside of the program schedule during bedtime hours. Confidential interviews indicated the clients are informed at intake the process for leaving the facility and the reason for their placement in care. Confidential interviews indicated staff clean the facility and clients are encouraged to clean their bedrooms. Confidential interviews indicated there is a laundry schedule and clients leave their laundry basket outside of their bedroom for staff to wash. Confidential interviews indicated bedding is changed during the week and clients place the bedding in their laundry basket, and staff wash the laundry. Confidential interviews indicated malodors can come from clients' personal hygiene or medical issues. Confidential interviews denied clients having access to knives at the facility. Confidential interviews did not produce evidence to conclude that staff have inappropriate conversations with clients in care. Based on confidential interviews the allegations that staff do not ensure youths receive medical care in a timely manner, staff do not ensure care and supervision is provided to youths, staff do not ensure youths are allowed to make and receive phone calls, staff do not ensure regular communication is provided to youths, staff do not ensure care and supervision is provided to youths, staff do not ensure facility is kept in clean, safe, sanitary conditions for youths, staff do not ensure facility is kept free of malodors, staff does not ensure youths are provided with clean linens and staff have inappropriate conversations with youth in care may have occurred or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Diana Peloso, Assistant Program Director.

Investigation Findings:
13On December 19, 2024, at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Diana Peloso, Assistant Program Director to discuss the investigative findings for the allegations noted above. LPA Jauregui conducted an inspection of the facility on April 10, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed six staff (S1-S4, S6-S7, S9) and two clients (C1-C2). On April 09, 2024, Community Care Licensing (CCL) received the allegations that staff do not ensure youths receive medical care in a timely manner, staff do not ensure care and supervision is provided to youths, staff do not ensure youths are allowed to make and receive phone calls, staff do not ensure regular communication is provided to youths, staff do not ensure care and supervision is provided to youths, staff do not ensure facility is kept in clean, safe, and sanitary conditions for youths, staff do not ensure facility is kept free of malodors, staff do not ensure youths are provided with clean linens and staff have inappropriate conversations with youth in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SOUTHWEST KEY PROGRAM, UNACCOMPANIED MINORS GHFACILITY NUMBER: VISIT DATE: 12/19/2024

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


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews indicated staff were not aware of C1 having scissors in their bedroom. Confidential interviews indicated staff conducted inventory on their sharps before and at the end of their shift. The investigation did not provide evidence to indicate that C1 had scissors in their bedroom. Relative to the allegations that staff did not prevent a minor from threatening another minor in care and staff do not protect minors from another minor in care, confidential interviews indicated there was an incident in which C1 became escalated and engaged in property destruction in the kitchen and became aggressive towards a staff. Confidential interviews indicated that the staff member was removed and replaced by another staff. Confidential interviews indicated C1 continued to be escalated, not following program rules. Confidential interviews indicated it was bedtime hours and C1 asked staff for a snack. Confidential interview indicated staff allowed C1 to grab more than one snack however, C1 grabbed more snacks than told to. Confidential interview indicated C1 came back and asked for more snacks. Confidential interview indicated staff did not provide C1 for with more snacks due to C1 not following staff's instruction regarding snacks. Confidential interview indicated C1 escalated and pulled the facility's fire alarm multiple times that night. Confidential interviews indicated a client questioned C1's behavior which led to C1 to become upset and confront the client. According to confidential interviews, staff intervened by stepping in between the clients. Confidential interviews indicated law enforcement was called, and law enforcement and the fire department arrived at the facility and spoke with C1. Confidential interviews indicated C1 was not taken into custody by law enforcement due to the nature of C1's placement. Confidential interviews indicated, in an effort to protect clients or at clients' requests, a total of six clients were transferred to the other Southwest Key facility location, leaving C1 with two other clients who C1 developed a good relationship with at the facility. Based on confidential interviews the allegations that staff do not prevent a minor from having access to scissors while in care, staff did not prevent a minor from threatening another minor while in care, and staff do not protect the minors from another minor while in care may have occurred, however, the allegations are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Diana Peloso, Assistant Program Director.

Investigation Findings:
13On December 19, 2024, at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Diana Peloso, Assistant Program Director to discuss the investigative findings for the allegations noted above. LPA Jauregui conducted an inspection of the facility on May 8, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed four staff (S1, S3-S5) and one client (C2). LPA attempted to interview one staff (S2) however, after numerous attempts LPA was unsuccessful. On May 1, 2024, Community Care Licensing (CCL) received the allegations that staff do not prevent a minor from having access to scissors while in care, staff did not prevent a minor from threatening another minor while in care, and staff do not protect the minors from another minor while in care. It was reported that C1 had scissors in their room. It was reported that on 4/31/24 there was a youth who was threatening staff and youth to the point where law enforcement was called. Lastly, it was reported that clients expressed feeling unsafe at the facility and were being encouraged to not file grievances. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SOUTHWEST KEY PROGRAM, UNACCOMPANIED MINORS GHFACILITY NUMBER: VISIT DATE: 12/19/2024

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


facility_name: SOUTHWEST KEY PROGRAM, UNACCOMPANIED MINORS GH

summary: Facility Evaluation

raw_content:
Narrative:
On 2/16/2022 at 9: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an announced inspection. LPA Meza-Gonzalez met with Program Director (PD) Annahi Ruano and Assistant Program Director (APD) Luis Vega. The purpose of the inspection is to conduct a required annual inspection. The facility serves 15 ambulatory children ages 6 to 17 years. There are no clients in care. LPA Meza-Gonzalez toured the facility with PD Ruano and ADP Vega. LPA Meza-Gonzalez inspected the facility's interior and exterior areas. The facility is set up as follows: The license and personal rights of the clients are posted in the lobby. There are two clinical offices, a security office, staff break area, and staff restroom. The kitchen currently does not have any perishable food item as there is no clients in care. The kitchen has some sufficient non-perishable food items. The menus are posted in the dining room. LPA Meza-Gonzalez observed the kitchen and dinning areas to be clean, sanitary in and in good repair. The sharps are locked in the pantry in a lock box. Toxins are locked up in a cabinet in the laundry room. There are two fire extinguisher, one in the kitchen and one in the laundry room. The facility has 9 bedrooms, six with two twin beds and three with one twin bed. Each bedroom has adequate dresser and closet space. There are six bathrooms the clients share. There are two offices in main living area, one medical and one case manager office. The medications is locked up in a cabinet in the medical office. There is one first aid kit in the medical office. The medical office has store of PPEs. The grievance policy is posted in the communal area of the clients. The hygiene is stored in a locked closet in the communal area. Games and art products are stored in the recreational closet. There are two fire extinguisher in the communal area. There are two first aid kits in communal area. There is a staff office and a clothing closet located within the communal area. Continue on page There is 18 fire alarms six carbon monoxide tested and properly working throughout the facility. The last fire drill was conducted on 2/14/2022. The facility has three storage shed and a maintenance shed across from the facility and five sheds behind the facility. There is no bodies of water. The facility is clean, safe sanitary and in good repair. There is no staff assigned to facility as it currently not in use. The facility is operating within the limitation of the licensee. The facility has demonstrated compliance with Title 22, Division 6 of the California Code of Regulation. An exit interview was conducted with the licensee and a copy of this report was given to PD Ruano.

report_type: Facility Evaluation

met_with: Annahi Ruano and Luis Vega


summary: Facility Evaluation

raw_content:
Narrative:
On April 12, 2024 at 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced inspection. The purpose of the inspection is to conduct a required annual inspection. LPA Jauregui met with Program Director (PD) Luis Vega who provided LPA an indoor and guided tour of the facility.The facility serves 15 ambulatory children ages 6 to 17 years. The facility is a one story shelter with lobby, staff lounge, clinical office, security office, dinning room, kitchen, laundry room, medical office, courtyard and 10 bedrooms. The kitchen has minimal snacks for the day. Per Program Administrator meals are cooked in the San Diego facility and transported at every meal. LPA Jauregui observed the kitchen and dinning areas to be clean, sanitary and in good repair. The sharps are locked in the pantry in a safe. Toxins are locked up in a cabinet in the laundry room. The facility has 10 bedrooms, seven with two twin beds and three with one twin bed. Each bedroom has adequate dresser and closet space. There are six bathrooms the clients share. There are two offices in the court yard: medical office and one case manager office. The medications are locked in a cabinet in the medical office. The first aid kits are located in the medical office and in the courtyard. LPA observed kits containing he required items. The grievance policy is posted in the communal area of the clients. LPA observed hygiene closet for client personal care items. LPA observed inventory closet in the case manager office. Inventory closet contained, bed sheets, sandals, and clothes for client use. 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. Sports equipment/books were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguishers are properly charged and serviced, last date of services was August 2023. The facilities last disaster drill was held on March 7, 2024. Continued... The hot water temperature was measured throughout the facility. The facility was advised water temperature should be between 105 to 120. Per facility staff, no firearms or weapons are allowed in the facility. There are 21 cameras located in in the facility. LPA observed the following items posted: Personal Rights, Vocational Schedule, Recreation Schedule, Physical Education Schedule, Program Schedule, Call Schedule, and Case Manager Scheduled. LPA observed meal menu posted in the dinning room. The facility has three storage shed and a maintenance shed across from the facility and five sheds behind the facility. There is no bodies of water. There is a basketball court in the top blacktop and a soccer field in the lower field. LPA reviewed five out five staff files (S1-S5). The staff files have the required background information, health screenings, criminal record clearances, staff qualifications, and mandated reporting acknowledgements. LPA reviewed five out of five client files (C1-C5). LPA conducted two out of two staff interviews and two out of two client confidential interviews. Based on today's observations there are no deficiencies at this time. LPA conducted an exit interview and a copy of this report was provided to Luis Vega, Program Director.

visit_type: Annual

met_with: Luis Vega, Program Administrator


facility_name: SPANISH BAY HOME

raw_content:
Narrative:
The Department has investigated the complaint allegation that staff hit a minor while in care. During confidential interviews, three of three clients made consistent statements that they feel safe in the home and have not been hit by staff. All staff interviewed stated staff have not hit clients in care. S1 denied the allegation. Additionally, youth advocate states C1 has "made up stories "and has "made false allegations" in the past. Therefore, it is not possible to determine whether the allegation occurred or not. Based on the investigation, records reviewed, and interviews conducted, the complaint finding is unsubstantiated at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Ronilo Armada, Facility Manager. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13An unannounced complaint investigation was conducted by the Licensing Program Analyst (LPA) Connie Goldie on 04/16/2024 at 01: PM. During the inspection, LPA met with Ronilo Armada, Facility Manager, to discuss the findings of the complaint allegation. LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Alyssa Burgess, at the facility on 01/25/2024 which included a physical plant inspection, a staff interview and a record review of C1's file. LPA Burgess collected client and staff information- staff schedule for 01/21/2024. During the investigation, six staff and three clients were interviewed between 01/25/2024 and 04/08/2024. LPA Goldie conducted a record review on 04/02/2024 and 04/06/2024 of FAS history, facility file, C1's file, Incident Report dated 01/22/2024, and cross report. One client was unable to be interviewed as he is non-verbal. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall 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 SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SPANISH BAY HOMEFACILITY NUMBER: VISIT DATE: 04/16/2024

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

met_with: Ronilo Armada Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 3.17. Licensing Program analyst (LPA) Jennifer Baca arrived at the facility for the purpose of conducting a Post Licensing visit. LPA introduced herself and explained the reason for the visit. LPA met with Heygie Raguinio, Administrator, and Marlu Raquinio, Facility Manager. LPA was given a tour of the facility by Administrator and Facility Manager. The house has five bedroom and three bathrooms. Bedroom 1 is staff office, Bedroom 2 is Client 1, Bedroom 3 is Client 2, Bedroom 4 is vacant, and Bedroom 5 is vacant. LPA reviewed two client files and four staff files. LPA observed working smoke detectors and carbon monoxide detector. LPA observed a copy of the emergency evacuation plan, license, personal rights posted in the entrance of the facility. LPA observed seven days of non-perishible food and three days of perishable food. LPA observed all bedrooms to be neat and decorated appropriately. All cleaning supplies are stored in a locked cabinets. All medication are locked in a locked cabinet. LPA observed a complete first aid kit. LPA observed the staff training records. No deficiencies were found at this visit. A copy of this report was left with Heygie Raquinio, Administrator

met_with: Heygie Raquinio, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual inspection at the agency and met with staff Lucy Tancico and Facility Manager Ronilo Armada who assisted LPA with the inspection. The Administrator was away on vacation for this day, however was reachable by phone. LPA conducted a walk-through of the facility with staff and observed: four client bedrooms, one staff office, dining area, kitchen, living room, activity room, garage, three bathrooms, and laundry room. LPA observed the whole home to be clean and in good repair. Trash cans had lids. There was a menu, however it had not been updated in three weeks. There was an adequate amount of perishable and non perishable foods. The water temperature was maintained within the required range of 105 - 120 degrees Fahrenheit, for an average of 118.4 degrees Fahrenheit between two client bathrooms and the kitchen. There were adequate amounts of silverware, plates, and cups, in good condition. Knives/sharps are locked and inaccessible. Medications and files are locked and inaccessible. There was an electric kettle which the water measured at 196.1 degrees Fahrenheit, and it was not labeled as being above 125 degrees as required; however, staff labelled it during this inspection. All clients had a surplus of all clothing items needed. Clients had adequate hygiene products. The first aid kit had all required items. The outdoor space was clean and in good condition, with no visible hazards. LPA reviewed the drills conducted by the facility, and they are conducted as required. LPA was able to review the board meeting minutes, an found the board had been meeting as required. Initially, the board meeting minutes were not accessible due to the Administrator being away for this day, however she was able to have someone obtain them. LPA advised that in the future they be kept in a more accessible location. LPA observed the Emergency Disaster Plan (EDP), however it was missing some components, which are detailed in HSC1565(a). Administrator sent LPA the Adult Residential Facility EDP form, and it would meet these requirements, with some modifications. There were no complaint/grievance policy and procedures posted, however during this inspection FM posted them. The facility has a fire clearance as required. LPA gave a copy of it to Administrator for the facility records. LPA observed the planned activity schedule and learned that the facility does their best to adhere to it, however at times clients' behaviors prevent them from being able to complete the planned activity, and another activity is substituted. All medications were maintained appropriately and securely. Two out of three Psychotropic Medication Administration Records had multiple psychotropic medications on one page, and were not separated for each psychotropic medication. All clients had the proper medical release consents and consent forms signed by their authorized representatives for medical care. However, none of the three clients who are taking psychotropic medications had authorized representative authorization. All of each clients' personal, medical, and dental information was included in the file. Each client has a completed Emergency and Identification form. All clients have a record of immunizations. All clients had recent IPP updates or Needs and Services Plan updates. On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Chapter 5, Sections: 84070(b)(12) and 84070(b)(13). LPA also issued Technical Violation Advisory Notes, which are not citations. LPA was unable to complete the inspection on this date and will return another day to complete the remaining inspection. An exit interview was conducted with staff and a copy of this report, confidential names list, and appeal rights were emailed to the Administrator and Facility Manager.

met_with: Lucy Tancico & Ronilo Armada


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual continuation inspection at the facility and met with Facility Manager (FM) Ronilo Armada, and Administrator Heygie Raquinio, who assisted with the inspection. LPA reviewed one Administrator file, one Facility Manager file, and three staff files. LPA found: All staff reviewed are qualified for their roles. Facility files contain job descriptions as required. All staff have been employed at the facility for under one year, and all have met the initial training requirements. The Administrator trains the staff on Reasonable and Prudent Parent Standards (RPPS), however has not used those words. LPA advised Administrator to inform the staff of that phrase and what it means, as well as documenting that staff have received RPPS training specifically, in their files. Currently, it is combined in with other trainings, and is not clearly specified. LPA found the Facility Manager training topics are not clearly detailed in the records, and advised Administrator to be more clear of the topics under the Facility Manager training, which needs to cover the topics listed under that regulation section. The Administrator's Group Home certificate expired in 11/2023, however Administrator submitted for renewal on 11/6/2023, and the CDSS Administrator Certification Section are currently backlogged, processing renewals from June 2023. The facility has three Facility Managers. LPA found that one Facility Manager (S4) did not have the correct job description in their file, and therefore, did not sign that they have received the one hour Facility Manager training, as this facility utilizes the job descriptions as the document they sign to demonstrate the Facility Manager training was completed. LPA advised Administrator to update that form to clearly state the required Facility Manager training topics, and a space to document the length of time for the training. LPA interviewed two staff and two children. LPA found that staff interviewed are knowledgeable about their job and duties, and that the facility is meeting the childrens' needs and personal rights. LPA is issuing three Technical Violation Advisory Notes, which are not citations, detailed on the following pages. An exit interview was conducted with Administrator and a copy of this report and appeal rights were issued to her.

visit_type: Case Management


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On Friday, November 1st, 2024, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced annual inspection at the Facility. Staff member Lyzette Parra answered the door and allowed LPA entry into the facility. Facility Manager Ronilo Armada arrived shortly after and assisted with the physical plant inspection. The Administrator, Heygie Mae Raquinio arrived around 10:30am and assisted with the remainder of the inspection. LPA conducted a walk-through of the facility and observed: four client bedrooms, one staff office, dining area, kitchen, living room, activity room, garage, three bathrooms, and laundry room. LPA observed the whole home to be clean and in good repair. Trash cans had lids. There was a menu, however it was dated for 2 days in advance. LPA requested the current weeks menu, and it was provided. There was an adequate amount of perishable and non perishable foods. The water temperature for one client bathroom sink was over the required range of 105 - 120 degrees Fahrenheit, but was corrected during the visit. There were adequate amounts of silverware, plates, and cups in good condition. Knives/sharps are locked and inaccessible. Medications and files are locked and inaccessible. All clients had a surplus of all clothing items needed. Clients had adequate hygiene products. The outdoor space was clean and in good condition. LPA reviewed the drills conducted by the facility, and they are conducted as required. LPA was able to review the board meeting minutes, and found the board has been meeting quarterly. Meeting minutes did not list items as specified in Health and Safety Code 1520.1(f), the facility was cited a Type B citation for this (See 809-D). (Report continues on LIC 809-C). LPA observed the Emergency Disaster Plan (EDP) and recommended the facility update the plan to specify the location of the backup power source. The facility has a fire clearance as required. LPA observed the planned activity schedule. All medications were securely maintained. Psychotropic Medication Administration Records were separated on different pages for each psychotropic medication. All clients had the proper medical release consents and consent forms signed by their authorized representatives for medical care and for psychotropic medications. All clients have a record of immunization's. 2 out of the 4 clients in care did not have an updated Needs and Services Plan completed within the last 6 month minimum as required. The facility is being cited a Type B citation for this (See 809-D). On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Sections: 84063(a)(9) and 84068.3(a). LPA also issued Technical Violations and Advisory Notes, which are not citations. LPA was unable to complete the inspection on this date and will return another day to complete the remaining inspection. An exit interview was conducted with the administrator, and a copy of this report, and appeal rights were given.

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

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

met_with: Heygie Mae Raquinio


summary: Facility Evaluation

raw_content:
Narrative:
On Monday, November 4th, 2024, at 10AM, Licensing Program Analysts (LPA) Brittany Crass and Michelle Silvas, made an unannounced annual continuation inspection at the facility and met with Facility Manager (FM) Ronilo Armada. The Administrator, Heygie Mae Raquinio arrived later, and assisted with the inspection. LPA reviewed one Administrator file, one Facility Manager file, and three Direct Care Staff files. LPA found: Facility files contain job descriptions as required. The Administrator trains the staff on Reasonable and Prudent Parent Standards (RPPS). LPA advised the Administrator to separate the Facility Manager training apart from the general orientation training, as well as to list the topics covered as specified under regulation section 84065(k). The Administrator's Group Home certificate expires in 11/2025. All employed staff have a valid fingerprint clearance. S3 was hired within the last 30 days, and is on-call, and has not yet completed their initial 8 hour training. S4 has not yet completed their 16 hour training due to being part-time. Per regulations, S4 has until 12/2024 to complete the 16 hour training. All five of the staff files reviewed had a valid CPR/First Aide certificate. LPA interviewed two staff members and two clients. LPA found that staff interviewed are knowledgeable about their job and duties, and that the facility is meeting the children's needs and personal rights. LPA is issuing four Technical Violations, and one Advisory Note, which are not citations, and are detailed on the following pages. An exit interview was conducted with Administrator and a copy of this report and appeal rights were given.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess conducted an unannounced annual inspection at the facility and met with staff Lyzette Parra, who assisted with the inspection. Facility Manager Marlu Raquinio and Administrator Heygie Raquinio arrived to assist. LPA interviewed two staff and one client. Interviews with staff demonstrated that staff have an understanding of the clients in their program, however LPA recommends a mandated reporter training to refresh staffs' understanding of how to report as mandated. LPA conducted a walk through of the facility with FM Raquinio. LPA observed: four client bedrooms, one staff office, dining area, kitchen, living room, activity room, garage, three bathrooms, and laundry room. LPA observed the whole home to be clean and in good repair. Trash cans had lids. There was a menu, however the clients change what they want daily, even when they were involved in the menu planning. There was an adequate amount of perishable and non perishable foods. The water temperature was maintained within the required range of 105 - 120 degrees Fahrenheit, at 116.4 degrees Fahrenheit in the client bathroom. The coffee machine was labelled for hot water. All clients had a surplus of all clothing items needed. Clients had adequate hygiene products. The first aid kit had all required items. The outdoor space was clean and in good condition, with no visible hazards. The AC unit was not inaccessible, so Administrator had staff purchase a cover, and installed it during the inspection. LPA reviewed the drills conducted by the facility for the past year, and they are conducted as required. LPA reviewed the board meeting minutes for the past year, finding that the board had been meeting as required and are discussing required topics. The facility's Emergency Disaster Plan is complete and reviewed at least annually for necessary updates. LPA reviewed four client files in part and found the following: all clients had signed admissions agreements, JV223 (one client) & parental consent for psychotropic medications (three clients) as required. Three clients' cash resources were accurate and one clients' was not. One client was over by $13.09 due to staff having not made change two transactions prior. During this inspection, the change was made and the $13.09 was balanced out. The on hand client cash resources did not surpass the bond limit. One client was receiving allowance as required, sourced from their P&I funds. All clients had up to date Needs and Services Plans, however they were not signed by the facility personnel. During this inspection, Administrator signed the Needs and Services Plans. LPA was unable to complete the inspection on this date due to the time. LPA will return another day to complete the inspection. An exit interview was conducted with Administrator and a copy of this report was provided to her.

met_with: Lyzette Parra


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual continuation inspection at the facility and met with staff Lucy Tancioco and Administrator Heygie Raquinio who assisted with the inspection. LPA completed the review of four client files and client medications, finding the following: All clients have had TB tests or screening for taking the TB test, medical records, immunization records, accurately maintained medications, signed and complete Needs and Services Plans which have been updated as required, and have attended medical appointments as required. LPA reviewed one Administrator file, three Facility Manager files, and one staff file, finding the following: Staff are fingerprint cleared and associated to the facility as required. All staff reviewed have individual files which are kept confidentially and contain: the required basic identifying details, personnel record, health screenings with TB tests, employee rights, employee duties, criminal record statements, statement acknowledging the requirement to report child abuse, facility manager training, CPI training, annual/initial training, CPR/First Aid training, education/experience records, and a valid driver's license. LPA will interview one client at their school, due to them not being at the facility during the inspection. An exit interview was conducted with Facility Manager and Administrator and a copy of this report was provided to her.

met_with: Lucy Tancioco and Heygie Raquinio


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Five out of six interviews confirmed that the injury was severe acne and a sunburn from basketball. Two interviews did say that one youth accidentally struck another youth, however, this was unable to be confirmed, and one youth partially recanted the statement. LPA confirmed that there was adequate staff for supervision. Although the allegation may have happened or is valid there is not a preponderance of the evidence standard to prove the alleged violation did occur therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and Appeal Rights were discussed with Lucy Tancioco, Facility Manager. A copy of this report and Appeal Rights were left at the facility.

Investigation Findings:
13On 4/23/ Licensing Program Analyst (LPA) Sara Luman-Gonzalez conducted an unannounced visit to the above Group Home (GH) to deliver the findings of a complaint investigation. LPA met with Lucy Tancioco, Facility Manager and was granted entry. During the investigation, LPA conducted the 10-day inspection of the GH on 1/15/2026; LPA obtained Four Facesheets, Individual Service Plans, Individual Program Plans, Client Roster, Staff Roster, Staff Contact Information, Staff Schedule for December 2025 and January 2026, Needs and Services Plans, Medical Reports from December 2025 to January 15, 2026. Six confidential interviews were conducted between January and April 2026. Based on interviews conducted throughout the investigation, LPA received inconsistent statements as to whether there was an injury. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Sara Luman-Gonzalez 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: SPANISH BAY HOMEFACILITY NUMBER: VISIT DATE: 04/23/2026

met_with: Lucy Tancioco, Facility Manager


facility_name: SPECTRUM PLACE

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Licensee cared for resident R1 on her own, residing in the facility with R1 until R1's home visit on 12/18/21 and then again when R1 returned, from 1/3/22 to 2/1/22 when R1 was placed in a new facility. Authorized representative statements confirm that Regional Center did not receive notice of there being no newly hired administrator to replace the former administrator nor that licensee was the sole caretaker at that point and was taking over the role of administrator and caretaker. Further, CCL was not notified of the change of administrator when licensee took over the administrator role. Additionally, per the program plan and the program's LIC Group Home Program Statement, the facility is to maintain at minimum a 1:6 childcare worker to resident ratio. The program plan includes in the program description a discussion of the consumer notes binder and lists as a section to be maintained "Overnight visits away from the facility." The program plan also lists under the job description for licensee that licensee is to "employ staff as necessary to ensure provision of care and supervision to meet consumers' needs." Licensee stated that there were staff available to hire but that she did not hire them because she was able to care for R1 on her own due to R1 having manageable behaviors. While licensee was the sole caretaker, the consumer shift notes were not completed, the home visit was not documented and filed in R1's binder, and discharge paperwork was not completed. As a result, LPA needed to verify dates of R1's home visit and R1's discharge with licensee's personal calendar, R1's parents, and the licensee of R1's new placement. The preponderance of evidence standard has been met, and therefore the above allegations are found to be Substantiated. LPA is issuing two citations of California Code of Regulations, Title 22, Sections Reporting Requirements and Plan of Operation. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report left with Licensee Rani Distefano, whose signature on this form confirms receipt.

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

met_with: Licensee Rani Distefano

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On 3/25/22 at 9:57AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Licensee Rani Distefano and informed of the purpose of the visit. Safety precautions were taken, including screening call, mask-wearing, and hand hygiene. LPA used the CARES Inspection Tool to conduct the inspection. There are no children in care and no staff currently working at the facility. The facility is temporarily closed pending the approval of a new administrator after the prior one resigned. LPA toured the facility site and grounds and observed the facility to be in safe condition. Licensee is currently redecorating the house and back yard. Room temperature and hot water temperature were maintained within permitted ranges, at F and 111. F, respectively. There are three double-occupancy bedrooms with beds in safe condition and clean linens. First aid kit was observed to be complete. During file review, LPA observed that complaint procedures were not posted and issued an advisory per California Code of Regulations Section 84072.2, advising the facility that complaint procedures should be posted in a location in the facility visible and accessible to residents and authorized representatives. No citations were issued at this visit. An exit interview was conducted, appeal rights provided, and a copy of this report left with Licensee Rani Distefano, whose signature on this form confirms receipt.

met_with: Licensee Kamilla "Rani" Distefano


summary: Facility Evaluation

raw_content:
Narrative:
On 1/18/23 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made a visit to the facility for a required annual inspection. LPA met with Licensee Rani Distefano and informed of the purpose of the visit. Safety precautions were taken, including screening call, mask-wearing, and hand hygiene. LPA used the CARES Inspection Tool to conduct the inspection. There are no children in care and no staff currently working at the facility. The facility is temporarily closed pending the approval of a new administrator after the prior one resigned. LPA toured the facility site and grounds and observed the facility to be in safe condition. Backyard was safe and clear from obstruction. Room temperature and hot water temperature were maintained within permitted ranges, at F and 105. F, respectively. There are three double-occupancy bedrooms with beds in safe condition and clean linens. First aid kit was observed to be complete. During the inspection, LPA discussed Administration qualifications. Licensee informed LPA that they might have a potential Administrator with previous work experience. Licensee will send CCL bi-weekly/monthly updates. At this time, no citations were issued at this visit. An exit interview was conducted and a copy of this report left with Licensee Rani Distefano, whose signature on this form confirms receipt.

met_with: Rani Distefano


summary: Facility Evaluation

raw_content:
Narrative:
On 1/19/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a facility evaluation visit for a required annual inspection. LPA met with Licensee Kamilla "Rani" Distefano and informed of the purpose of the visit. LPA used the CARE Inspection Tool to conduct the inspection. There have been no placements since the facility's last annual, as the licensee has been working on hiring an administrator. LPA discussed this with the licensee, who informed LPA that an administrator has been hired to start working soon and that their group home administrator certificate will be forwarded to LPA upon receipt. There are currently no staff working at the facility. LPA toured the facility and observed no deficiencies. There is lockable storage for medications, sharps, and chemicals. The licensee has maintained the facility and activity spaces in good condition, so they are ready for residents. LPA did not observe any hazards inside the facility nor on facility grounds. Licensee agreed that a current LIC 610C would be submitted with administrator certificate. No deficiencies were found during the inspection. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Licensee Rani Distefano, whose signature on this form confirms receipt.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On March 5, 2025, at approximately 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced annual inspection at the facility. Upon arrival, LPA Medina initially met with Direct Support Professional (DSP) Harlyne Sally and later conducted the remainder of the inspection with Facility Manager Maria Tan. The facility is licensed to serve up to six clients. At the time of the inspection, one client, two staff members, and the Licensee were present. The client declined to be interviewed. At approximately 11: AM, LPA Medina began a physical inspection of the home using the CARES Inspection Tool. The facility has five bedrooms, one of which is designated for double occupancy. Currently, one client resides in the double-occupancy room. All bedrooms were observed to be clean, well-maintained, and equipped with adequate storage space. At approximately 11: AM, during an inspection of the laundry room, LPA observed an unsecured bucket of laundry detergent. LPA informed the DSP that leaving the detergent unsecured is a violation of Title 22 regulations. As a result, a Type A deficiency will be cited. Please refer to LIC 809-D for details. At approximately 11: AM, LPA inspected the backyard and observed that a section of the fence was broken. The Licensee discussed a plan to repair the fence. Please refer to LIC 809-D for further information. LPA tested the water temperature, which measured 118°F, within the acceptable range. The thermostat displayed a temperature of 66°F also within range. The living room was observed to be clean, well-maintained, and furnished in a manner that provides a comfortable space for clients. Continues on LIC809-C. Additionally, LPA noted that the facility did not have a posted Foster Youth Bill of Rights. Please refer to LIC 809-D for further details. At approximately 12: PM, LPA began reviewing staff files. The facility was unable to provide complete staff records upon request, including staff schedules, training records, and qualification documentation. Furthermore, during an interview, it was disclosed that an individual without fingerprint clearance had assisted at the facility on weekends. This is a violation of Health and Safety Code (HSC), section 1522(c)(1) regarding Criminal Record Clearance. Please refer to LIC 809-D for details. The inspection is not yet complete, and LPA Medina will return at a later date to continue the review. As a result of this inspection, seven deficiencies are being cited in accordance with California Code of Regulations, Title 22, Sections 84072(a)(1), 80087(g), 80087(a), 1522(c)(1), 80066(a), 84064(b), and 84065(i)(3). See LIC 809-D for details. Additionally, a civil penalty of $200 was assessed due to an unapproved staff member (S1) working in the facility for two days. An exit interview was conducted, and the report, along with appeal rights, was reviewed and provided to Facility Manager Maria Tan.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
84065(d): Personnel Requirements

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

met_with: Maria Tan - Facility Manager


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
*** Added Signature *** On April 3, 2025, at approximately 12: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced annual/random inspection continuation at the facility. Upon arrival, LPA Medina initially met with Direct Support Professional (DSP)/Facility Manager Harlyne Sally and later conducted the remainder of the inspection with Facility Manager Maria Tan. The facility is licensed to serve up to six clients. At the time of the inspection, one client, two staff members were present. The client declined to be interviewed. Per California Code of Regulations (CCR) Personnel Requirements 84065(d), a facility manager must be present at the facility at all times when children are present. LPA reminded staff of regulation, and a repeat violation was assessed as a result. Please refer to LIC809-D. At approximately 1: PM, LPA Medina began a review of the client records using the CARES Inspection Tool. Upon review client record was missing a Needs and service Plan. After review of program statement all clients should have a needs and service plan created for them upon admission. Please refer to LIC809-D. At approximately 1: PM, LPA began reviewing the facilities disaster preparedness folder. Facility had LIC610C updated with all staff and required assignments during an emergency. Facility Manager was not able to provide proof of disaster drills being conducted quarterly upon request. Please refer to LIC809-D. Continues on LIC809-C. *** Removed deficiency regarding fire clearance *** At 2: PM, LPA began reviewing emergency intervention section of the CARES Inspection Tool. LPA confirmed staff were Pro-Act trained or in the process of taking the course. No deficiencies were noted in this section. At 2: PM, LPA began reviewing the operational requirements section of the CARES Inspection Tool. LPA confirmed this home runs under a Sole-Proprietorship and no board of directors' meetings are necessary. LPA confirmed that the client is currently enrolled in school but has been unwilling to attend due to unspecified personal reasons. The home has created activities for the client to do while at home such as doing chores,going on outings, and meetings with CASA worker every Thursday. Lastly, because the LPA did not conduct a visit within 10 days for a past-due deficiency, the deficiency was reissued during today's visit. The following deficiency was reissued in accordance with California Code of Regulations (CCR) section 84064(b) regarding Personnel Requirements, due to the home not having a certified Administrator. The inspection is now complete. As a result of this inspection, five deficiencies are being cited in accordance with California Code of Regulations, Title 22, 84065(d), 84068.2(a), 84064(b), and 84072.2(a). In accordance to Health and Safety Code (HSC) the following deficiency 1565(c) was given. See LIC 809-D for details. Additionally, a civil penalty of $250 was assessed due to a repeat deficiency of not having a facility manager present while having clients in care. An exit interview was conducted, and the report, along with appeal rights, was reviewed and provided to Facility Manager Harlyne Sally.

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: Maria Tan - Facility Manager, Harlyne Sally - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 5/15/2025, Licensing Program Analyst (LPA) Jonathan Medina made a visit to the home regarding outstanding Plans of Correction (POCs). Upon entering the home, LPA met with Maria Tan, Facility Manager, and informed her of the reason for the visit. LPA reviewed the outstanding POC issued on 04/03/2025 regarding the requirement to maintain records of emergency drills at the facility. The Facility Manager provided documentation confirming that the last drill was conducted in February 2025, which falls within the current quarter and meets regulatory requirements. LPA verified the documentation and cleared the POC. LPA also amended the POC issued on 04/30/2025 and extended the due date to 05/19/2025. The extension was granted due to unclear language in the original deficiency, which did not specify that the licensee may submit a request to update the facility's Program Statement to serve clients outside of the currently approved population. The facility is currently licensed to serve developmentally disabled clients; however, record review revealed that one client does not meet the criteria for this population. During the visit, the Facility Manager stated an interest in also serving non-ambulatory clients in the future. LPA reminded the Facility Manager that, prior to accepting any clients outside the current approved parameters, the following must be submitted and approved by the Department: Continues on LIC809-C A revised Program Statement reflecting the proposed changes, Supplemental documents of approval from the placing agency (e.g., county or regional center), social worker, or legal guardian, A detailed plan outlining how the client's needs will be accommodated, and An updated and approved fire clearance from the local fire authority. An exit interview was conducted, and the report, along with appeal rights, was reviewed with and provided to Facility Manager, Maria Tan.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/30/ Licensing Program Analyst (LPA) Jonathan Medina made a visit to the facility for a review of deficiencies made during Annual Inspection and assess POC. LPA met with Harlyne Sally and informed of the purpose of the visit. On a visit to the home on 4/16/ LPA Medina visited the facility to amend deficiency regarding fire clearance due to the facility maintaining it in original physical file located in San Bruno Regional Office. LPA also assessed a penalty for failure to correct California Code of Regulation Section 84068.2(a). Due to an error from LPA not making a facility evaluation report for visit on 4/16/25 the citation is cleared and home will not be billed the penalty. On todays visit LPA checked to see if deficiency has been corrected regarding clients Needs and Service Plan 84068.2(a). LPA confirms Needs and Service Plan is complete and deficiency will be cleared. Additionally, in accordance to facilities license and program statement the home is licensed to serve developmentally disabled clients. Upon review of updated client files client does not fit current population served. One deficiency is being cited under California Code of Regulations, Title 22, Section 80022(k) Plan of Operation. Please refer to LIC809-D. An exit interview was conducted, and the report, along with appeal rights, was reviewed and provided to Facility Manager, Harlyne Sally .

met_with: Harlyne Sally - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 4/13/22 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility regarding a deficiency found during an investigation at the facility. LPA met with Licensee Rani Distefano and informed of the purpose of the visit. Safety precautions were taken, including pre-visit screening call and mask-wearing. Based on record review and interviews, licensee did not notify resident R1's (See LIC Confidential Names, dated 3/14/22) authorized representative that resident needed to be relocated to another facility due to the facility being unable to meet R1's needs when the facility's administrator and only direct care staff resigned. Based on licensee's statements and record review, the staff resigned on 12/12/21 and licensee was the sole caretaker from 12/12/21 to 12/18/21 and again from 1/3/22 to 2/1/22. While licensee was the sole caretaker, certain care staff duties were not completed, such as daily consumer notes and documentation of important dates, such as home visit and discharge. Licensee did not notify the authorized representative that R1 would need a new placement until 12/20/21, and licensee's communication with the authorized representative was not clear about licensee being the sole caretaker and that the facility could not meet R1's needs. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84068. Removal and/or Discharge Procedures. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report left with Licensee Rani Distefano, whose signature on this form confirms receipt.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 02/11/2026 at 10:20AM, Licensing Program Analyst (LPAs) Jonathan Medina and Will Ea conducted an unannounced Annual Inspection at the above listed facility. LPA met with Lynette Sandobal, Administrator. The Group Home Facility is licensed to serve 6 clients. Present during the inspection were 1 staff and 1 client. At 10:20AM, LPAs conducted a tour of the facility. LPAs observed four bedrooms and two bathrooms. There is an additional bedroom in the facility, however it is currently inaccessible due to the key being removed by a former staff member. Each bedroom was furnished with private storage, functional lighting, and clean linens. LPAs observed the facility license, Personal Rights, facility sketch, meal menu, and other required forms posted throughout the facility, however complaint procedures were not posted which led to a type B deficiency. LPA Ea tested the water temperature and found it to be 119.6 degrees Fahrenheit, which meets the acceptable limit. The thermostat reading was 70 degrees Fahrenheit, which is also within the acceptable range. Sharps were locked, medications, and chemicals were safely stored. LPAs observed at least two days of perishable food and seven days of non-perishable food on site with all foods labeled with date and time opened and expiration date. LPAs walked around the facility perimeter and found the outside space in good repair. LPAs conducted one confidential interview with staff. (continued on LIC-809-C) At approximately 1:00PM, LPAs began reviewing staff files. The facility was unable to provide complete staff records upon request, including staff schedules, training records, and qualification documentation. During the inspection, LPAs learned that the facilty has a new administrator and CCLD was not informed, however no citation is being issued, because the new administrator is still within their first 10 days of hire. Furthermore, during record review, it was revealed that three staff without fingerprint clearance had assisted at the facility and is currently working as direct care staff. This is a violation of California Code of Regulations (CCR), section 80019(e)(2) regarding Clearance. A civil penalty was assessed for the amount of $1,500 for three staff members at $100 per day, working at the facility. LPAs assessed for a total of five days per staff. Please refer to LIC 809-Ds for additional details. At approximately 2:30PM, LPAs began reviewing client files. The facility was unable to provide complete client files upon request, including immunization records, health screening, personal rights, and admission agreement. Please refer to LIC 809-Ds for additional deficiency details. However, client did possess an Individual Service Plan for current quarter, a signed needs and services plan, and inventory of personal items. One staff interview was conducted. The inspection is not yet complete, and LPAs will return at a later date to continue the inspection and to conduct additional interviews. As a result of this inspection, twenty-one deficiencies are being cited in accordance with California Code of Regulations, Title 22, Sections 80019(e)(2), 84065(i)(1)(C)(4), 84072.2(a), 84365(d), 80066(a), 80065(g)(1), 80065(g)(2), 84065(b)(1)(A), 84065(d)(1), 84065(d)(3), 84065(i)(1)(D), 84065(i)(3), 84065(i)(3)(C), 84065(i)(3)(F), 84065(i)(3)(M), 84065(k), 80075(f), 84070(b)(17), 84068.1(b)(4)(B), 84066(b), and 84064(b). An exit interview was conducted at 5:30PM, and the report, along with appeal rights, was reviewed and provided to Administrator Lynette Sandobal.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
84066(b): (b)	The licensee shall maintain the following personnel records

met_with: Lynette Sandobal, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An online, informal meeting was held on August 1, 2025, at 11: AM via Microsoft Teams. The purpose of the meeting was to discuss concerns observed by the department. Attendance: Community Care Licensing: · Licensing Program Manager (LPM): Joel Segura · Licensing Program Analyst (LPA): Jonathan Medina Facility Representatives: · Licensee: Rani Kamilla Distefano · Facility Manager: Maria Tan Agenda: The following topics were discussed based on concerns observed during past inspections and proposed program changes: A. Past Citations/Issues On January 5, 2022, the facility received two substantiated complaint findings under complaint number 14-CR-20220105092833. Allegations included: · The facility did not have an Administrator. · The facility did not have adequate staffing. Continues on LIC809-C (Page 2 of 3) As a result, the LPA issued citations for violations of: California Code of Regulations, Title 22, Section 84061 - Reporting Requirements Section 80022 - Plan of Operation Following the complaint, the home was placed on a restriction by the Regional Center of the East Bay (RCEB) until proof of adequate staffing could be provided. This reflected an ongoing pattern of noncompliance. Current Issues: On March 5, 2025, at approximately 10: AM, LPA Jonathan Medina conducted an unannounced annual inspection at the facility using the CARE Tool. Only the physical plant and staffing sections were completed during the initial visit. Key findings included: No staff files were available for review. No Administrator had been hired. The facility manager was not on payroll and was only available on call. Only one staff member was officially on payroll; the others were considered "volunteers." As a result, nine deficiencies were cited under California Code of Regulations, Title 22: 80087(g) - Buildings and Grounds 80087(a) - Buildings and Grounds 80066(a) - Personnel Records 84066(b)(3) - Personnel Records 84064(b) - Administrator Qualifications and Duties 84072(a)(1) - Personal Rights 84065(b)(1)(A) - Personnel Requirements 84065(d) - Personnel Requirements 84065(i)(3) - Personnel Requirements Continues on LIC809-C (Page 3 of 4) Additionally, one deficiency was cited under Health and Safety Code Section 1522(c)(1) - Fingerprints and Criminal Records. A civil penalty of $200 was assessed for allowing a staff member to assist in the facility without fingerprint clearance. On April 3, 2025, LPA Medina returned to continue the annual inspection. The following issues remained: Ongoing noncompliance with CCR Section 84065(d) - A facility manager must be present when children are in care. Client records lacked completed Needs and Services Plans. The facility still did not have a qualified Administrator. The previously cited deficiency was re-assessed due to the LPA not returning within the 10-day time frame. B. Program Statement Revision We discussed the extent of requirements necessary to revise the Program Statement in order to expand the population served. Facility Manager Maria Tan stated that the facility would prefer to maintain the currently approved Program Statement after discussion. In addition current client has been put into Regional Center system. C. Current Staff Working at the Home Maria Tan Rani Kamilla Distefano Patti Inouye Robert Macaraeg (pending clearance) D. Available Support Resources The Technical Support Program (TSP) was introduced as a voluntary, non-enforcement resource designed to help providers meet regulatory compliance. TSP offers one-on-one consultation, training, and access to various Community Care Licensing (CCL) resources. Continues on LIC809-C (Page 4 of 4) E. Facility CEO Update Upon reviewing the Secretary of State Articles of Organization, the LPA noted that the Chief Executive Officer (CEO) had changed from Kamilla Distefano to Elizabeth Cortes. The Licensee explained that the home was not sold, nor was there any intention to relinquish ownership. F. Follow-Up During the meeting, a plan for achieving compliance was discussed. TSP services were offered to assist with record keeping requirements, and the facility expressed interest in receiving that support. A copy of this office visit summary was provided to facility and signed copy will be filed in facility folder.

met_with: Licensee: Rani Kamilla Distefano and Facility Manager: Maria Tan


summary: Facility Evaluation

raw_content:
Narrative:
On 03/13/2026, Licensing Program Analyst (LPA) Jonathan Medina conducted a visit to the facility to follow up on outstanding Plans of Correction (POCs). Upon arrival, no one was at the home because staff were dropping off a client at school. LPA later met with Administrator Lynette Sandobal, Ruby Negrette and informed them of the purpose of the visit. During the visit, Kamila Rani Distefano also arrived at the facility. During the visit, LPA reviewed the outstanding POCs issued on 02/11/2026 during the facility's annual inspection. As a result of that inspection, the facility received 21 deficiencies. The deficiencies included lack of required staff trainings, an outdated First Aid certificate, missing health screenings, failure to post written complaint procedures, missing mandated child abuse reporting forms, fingerprint clearance issues, and the facility operating without a qualified Facility Manager and Administrator. During today's visit, LPA observed that staff created a training plan identifying the trainings that staff are required to complete and have been actively working to complete those trainings by the due dates. Staff also reported that the Pro-Act training has been rescheduled for the following week. However, the facility continues to operate without a qualified Administrator and Facility Manager. Administrator Lynette Sandobal does not meet the three-year experience requirement working with the population served. Facility Manager Ruby Negrete completed the one-hour Facility Manager training but does not qualify because she has not completed DSP II training. These requirements are also outlined in the facility's Program Statement. Continues on LIC 809-C The facility is therefore being cited for failure to correct and repeat deficiencies under California Code of Regulation (CCR), Title 22, Sections 84064(b) and 84065(d)(1) totalling $450. During today's visit, LPA also reviewed staff records and observed that the previously cited deficiencies related to outdated First Aid certification, health screenings, staff files, training plans, and Guardian fingerprint clearances have been corrected. These deficiencies were cleared during today's visit, and cleared POC letters were provided. An exit interview was conducted at 1: PM. The report and appeal rights were reviewed with and provided to Kamila Rani.

met_with: Kaila Rani Distefano - Owner


summary: Facility Evaluation

raw_content:
Narrative:
On 04/14/2026 at 9:30 a.m., Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced inspection at the facility and met with Lynette Sandoval, Staff to follow up on outstanding Plans of Correction (POCs). LPA Medina disclosed the purpose of the visit and was granted entry. At the time of the inspection, there was 1 staff member and client was at school.. On 02/11/2026, LPA Medina conducted the facility's annual inspection. LPA has not received POC for the following deficiencies. California Code of Regulations, Title 22, Section 84065(d)(1) - Personnel Requirements. California Code of Regulations, Title 22, Section 84064(b) - Administrator Qualifications and Duties. During today's visit, LPA Medina reviewed the Plans of Correction (POCs) with Lynette Sandoval. Both POCs were due on 03/11/2026. On 03/13/2026, LPA conducted a POC visit and initiated a civil penalty at a rate of $100 per day, which has continued to accrue. From 03/13/2026 to today's date, 04/14/2026, a total of 32 days have passed, resulting in $3,200 per deficiency, for a total of $6,400. During today's visit, LPA checked in with Ms.Sandoval regarding the status of both POCs. She informed LPA that she has obtained her Administrator Certificate. However, Ms.Sandoval does not meet the three-year experience requirement for the population served. Additionally, facility managers are required to complete DSP 1 and DSP 2 trainings in accordance with the requirements outlined in the Program Statement. Facility managers are only required to have one year of experience supervising the population served. An exit interview was conducted. The report, along with appeal rights, was reviewed with and provided to Lynette Sandoval. Signature on this report acknowledges receipt.

met_with: Lynette Sandoval - Staff


facility_name: STARLIGHT HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 6/9/22 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicant/Administrator Lonnie Holmes and Board Member Joanna Tang via Microsoft Teams to conduct the Component II of the orientation process. The following items were discussed: - Physical Plant and the use of the facility. The facility has 10 bedrooms and will serve up to 20 male youth, preferring ages 12-17 years. - Administrator understands the requirement to be on site as many hours as necessary to maintain compliance with applicable regulations and requirements. - Staff will receive training on medication, emergency intervention, and other required topics for the mandated hours, as specified in the applicable regulations. - Title 22 regulations and Health and Safety Code required were reviewed. - Program operations, services, and contracted professionals were discussed. Applicant agreed to send over the full articles of incorporation. Upon completion of management's review of the program, LPA Hawkins will contact Applicant to schedule the Component III Pre-Licensing Inspection. An exit interview was conducted, and a copy of this report was provided to Applicant/Administrator Lonnie Holmes, whose signature confirms receipt.

met_with: Administrator/Applicant Lonnie Holmes, Board Member Joanna Tang


summary: Facility Evaluation

raw_content:
Narrative:
On 7/26/22 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins and Licensing Program Manager (LPM) Isabel Mendoza conducted a prelicensing inspection at the facility. LPA and LPM met with Director/Administrator Lonnie Holmes and CFO Joanne Tang. Safety precautions were taken, including mask-wearing and hand hygiene. The CARE Inspection Tool was used to conduct this inspection. The facility will have a capacity of 20. The facility was observed to be overall clean, organized, and in good repair. The kitchen is not currently stocked, but the facility has sample meal plans and storage space that would support the quantity needed to provide for intended population. During visit, LPA and LPM went over applicable regulations, personal rights, documents that need to be posted, and list of forms and documents to be maintained at the facility in personnel, facility, and resident records. The below items were observed that need to be addressed and for which advisories were issued (see attached LIC 9102s). At 1:45PM, LPA and LPM observed that mattresses did not have mattress pads. However, the facility has mattress pads in storage. The facility is advised to ensure mattresses have mattress pads prior to accepting placements. At 1:57PM, hot water in the downstairs hallway bathroom (bathroom 2) measured 133. F. The hot water setting was lowered, and at 4:20PM, hot water measured at 130. F. The facility is advised to ensure the hot water temperature is lowered to within permitted range specified in the provided regulation above prior to accepting placements. Verification of hot water within range will be sent to LPA Hawkins. At 2:49PM, LPA and LPM observed a sagging water stain in the bathroom nearest the kitchen (bathroom 1). The facility has plans to hire an inspector to assess and address the stain. The facility is advised that this issue needs to be addressed and is advised to provide LPA and LPM updates of their progress on this and notify of any serious concerns or significant findings as well as when the issue has been addressed and solved. At 2:20PM, LPA and LPM observed four (4) bricks/stones in the back and side yards, which could be picked up and pose a risk to youth or staff. The facility is advised to remove these from the premises. At 4PM, LPA and LPM inspected the first aid kits and observed that tweezers were missing. The facility is advised to acquire first aid tweezers and ensure they are added to first aid kit(s). Provisional licensure is anticipated for 7/27/22. The facility agrees to follow-up regarding the above items with LPA Hawkins and LPM Mendoza. An exit interview was conducted, and a copy of this report was left with Director/Administrator, whose signature on this form confirms receipt.

visit_type: Prelicensing

met_with: Director/Administrator Lonnie Holmes; CFO Joanne Tang


summary: Facility Evaluation

raw_content:
Narrative:
On 9/21/22 at 10:30AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Director/Administrator Lonnie Holmes and CFO Joanne Tang and informed of the purpose of the visit. The purpose of the visit was to sign amended reports. The Office Meeting report, dated 06/09/2022 and Prelicensing Visit, dated 07/26/2022, are being amended to remove protected information. LPA discussed the changes, which have no impact on the license status of the facility. An exit interview was conducted, and a copy of this report was left with Director/Administrator Lonnie Holmes, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/19/23, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator Lonnie Holmes and informed of the purpose of the visit. The Inspection Tool was used to conduct this inspection. The facility has had no placements since licensure, and the program is in the process of shifting program type. LPA toured the facility site and interviewed one staff. The facility is in good condition, and there are no hazards. Bathrooms and kitchen are maintained in sanitary condition. The bedrooms are ready for placements. There are no deficiencies. An exit interview was conducted, and a copy of this report was left with Administrator Lonnie Holmes, whose signature on this form confirms receipt.

met_with: Administrator Lonnie Holmes


facility_name: STEPHENS & KELLY CHILDRENS CARE SERVICES, INC.

summary: Facility Evaluation

raw_content:
Narrative:
On June 23, 2021, Licensing Program Analysts (LPAs) Tamara Melikian and Eduardo Barragan conducted an unannounced annual required inspection at the facility. LPAs was met at the facility by House Manager Bettina Glover and spoke to Administrator Steve Stephens by phone. An inspection of the facility was conducted and the following was observed: Client and staff files were inspected on this date. The facility was inspected indoors and outdoors. Hot water temperature measured at 106 degrees. Observed adequate supply of perishables and non-perishables. Observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals inaccessible to clients. Medications centrally stored and locked. There are no pets at the facility. Per the Administrator, there are no weapons at the facility. There are no bodies of water at the facility. There have been no deficiencies in the prior 12 months. A review of staff records on 6/23/2021, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Deficiency on the attached page. LPA's left a copy at the facility. The visit was then concluded.

met_with: Bettina Glover


facility_name: STOREFRONT EMERGENCY SHELTER

raw_content:
Narrative:
Based on confidential interviews the allegations that C1 was inappropriately touched by C2 in care due to a lack of supervision by staff may or may not have occurred, however, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. No deficiencies were cited. An exit interview was conducted and a copy of this report and appeal rights were given to RC Bayardo.

Investigation Findings:
13On November 6, 2022, at 2: PM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced complaint inspection at the above facility. LPA Meza-Gonzalez met with Residential Counselor (RC) Jenny Bayardo. The purpose of the inspection was to deliver the findings of the complaint investigation. LPA Meza-Gonzalez conducted a safety check on December 1, 2021, and no deficiencies were found. During the investigation, LPA Meza-Gonzalez interviewed two staff (S1, S2), the Case Manager, and PA. LPA Meza-Gonzalez was not able to interview clients (see confidential name list, LIC811, dated November 6, 2022). LPA Meza-Gonzalez Intake assessments, progress notes, special incident report (SIR), and program exit sheets. On November 22, 2021, the Department received allegations that C1 was inappropriately touched by C2 in care due to a lack of supervision by staff. Confidential interviews revealed C2 touched C1's chest while saying good-bye to the other clients in the facility. Confidential interviews revealed that no one witness the incident. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: STOREFRONT EMERGENCY SHELTERFACILITY NUMBER: VISIT DATE: 11/06/2022

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

met_with: Jenny Bayardo


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
...CONTINUED Confidential interviews and records revealed that S1 remained C1's case manager for the duration of C1's stays at the facility despite being admonished for having an inappropriate relationship, crossing professional boundaries, and spending too much time with C1. A review of photographs and text messages indicated an intimate relationship had developed between S1 and C1 at some point, and that S1 asked C1 to lie to Storefront staff to conceal the nature of their relationship after C1 was no longer a minor. A confidential interview indicated that S1 made a comment to C1 while they were still a minor client regarding a future romantic relationship together, that their relationship became sexual while C1 was still a minor and attending a career training program, and that S1 would secretly sign C1 out of their program over the weekends to stay with S1; however, no witnesses to these incidents were named during the interview. A conflicting confidential interview indicated that S1 and C1's relationship was close-consisting of hugs, kisses on the cheek, and spending time together after hours-but denied that it was sexual; however, the interviewee could not explain the previously mentioned photographs. Records reviewed indicated that S1 signed C1 out of their career training program, as previously reported, while C1 was still a minor but not while C1 was a Storefront client. Although S1's interactions with C1 were inappropriate, the investigation did not yield sufficient evidence to conclude that the relationship was sexual. Based on conflicting confidential interviews and records reviewed, the allegation that staff engaged in an inappropriate sexual relationship with a minor while in care may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore, the allegation is unsubstantiated at this time. An exit interview was conducted with Renatta Escobedo, Administrator and a copy of this report and appeal rights were provided.

Investigation Findings:
13On July 31, 2025, at 12: PM, Licensing Program Analyst (LPA) Jacob Salem met with Renatta Escobedo, Administrator of Storefront Emergency Shelter (Storefront) to deliver the finding for the above-stated allegation. The investigation was conducted by Special Investigator (SI) Annette Renquist, who interviewed Clients (C1), Staff (S1-S4), a Relative, and a Witness. Pertinent records were obtained and reviewed. On February 19, 2025, Community Care Licensing (CCL) received an allegation that staff (S1) engaged in an inappropriate sexual relationship with a minor (C1) while in care. It was reported that S1 used their role as C1's case manager to secretly check C1 out of their career training program over the weekends and have sleepovers where they began a sexual relationship while C1 was still a minor. It was also reported that S1 had previously been admonished by Storefront management for spending excessive time with C1 and showing favoritism, including an incident where staff observed S1 and C1 "huddled together" during a case-management session and separating quickly when others entered the room. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Storefront Emergency Shelterfacility Number: Visit Date: 07/31/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED Confidential interviews and records revealed that S1 remained C1's case manager for the duration of C1's stays at the facility despite being admonished for having an inappropriate relationship, crossing professional boundaries, and spending too much time with C1. A review of photographs and text messages indicated an intimate relationship had developed between S1 and C1 at some point, and that S1 asked C1 to lie to Storefront staff to conceal the nature of their relationship after C1 was no longer a minor. A confidential interview indicated that S1 made a comment to C1 while they were still a minor client regarding a future romantic relationship together, that their relationship became sexual while C1 was still a minor and attending a career training program, and that S1 would secretly sign C1 out of their program over the weekends to stay with S1; however, no witnesses to these incidents were named during the interview. A conflicting confidential interview indicated that S1 and C1's relationship was close-consisting of hugs, kisses on the cheek, and spending time together after hours-but denied that it was sexual; however, the interviewee could not explain the previously mentioned photographs. Records reviewed indicated that S1 signed C1 out of their career training program, as previously reported, while C1 was still a minor but not while C1 was a Storefront client. Although S1's interactions with C1 were inappropriate, the investigation did not yield sufficient evidence to conclude that the relationship was sexual. Based on conflicting confidential interviews and records reviewed, the allegation that staff engaged in an inappropriate sexual relationship with a minor while in care may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore, the allegation is unsubstantiated at this time. An exit interview was conducted with Renatta Escobedo, Administrator and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

met_with: Renatta Escobedo, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 3/15/2022 at 10: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced inspection. LPA Meza-Gonzalez met with Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct a required annual inspection. The facility operates as an emergency shelter for ambulatory male and females children ages 12 to 17 years. Four client were present at the time of inspection. LPA Meza-Gonzalez reviewed eight client files (see confidential name list, LIC 811, dated 03/15/22). LPA Meza-Gonzalez observed the files to be complete and in order. LPA Meza-Gonzalez interviewed four out of eight clients. Due to time constraints, the annual inspection is being extended to inspect and review the physical plant, operations, disaster preparedness, emergency interventions, staff files and conduct staff interviews. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 was given to PA Escobedo.

met_with: Renatta Escobedo


summary: Facility Evaluation

raw_content:
Narrative:
On May 5, 2022 at 09: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced inspection. LPA Meza-Gonzalez met with Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct an annual continuation. The facility operates as an emergency shelter for ambulatory male and females youth ages 12 to 17 years whom are homeless or at risk of homelessness. Three client were present at the time of inspection. LPA Meza-Gonzalez inspected the physical plant inside and outside. The facility is two story building. The facility is set up as follows: The first floor is the drop-in day shelter with a TV room, art room, donation room, Case Manager room and a restroom. The main living area has a living room and four restrooms with two showers, kitchen and sleeping area. The main dorm room/bedroom for clients is arranged so that it sleeps a capacity of seventeen (17) clients divided by gender preference. There is one client per bed. There are multiple bunk beds (8 bunk beds plus one twin bed) available. (Waiver is on file dated 03/04/2014) There is adequate shelf and closet space for client's belongings. The facility also utilizes large chest for each client that exceeds eight cubic feet of drawer space. (Waiver is on file dated 03/04/2014). The bathrooms were clean and in good repair. The hot water in the client bathroom was measured at 105 degrees F which is within regulatory requirements between 105 degrees F to 120 degrees F. The medication is locked up in a locked box in a locked cabinet behind the staff desk. The laundry room has a washer and dryer for client's use. The extra linen is locked in the laundry room. Cleaning supplies is located in a locked cabinet in the staff area as well as in a locked shed in the courtyard. The First Aid Kit is located in the staff office and contained all required supplies. The facility's smoke detectors and carbon monoxide were checked and were operable. See LIC 809C page LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients in the pantry and the refrigerator. The second floor is for conference room, administration and clinical offices. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool located on the premises of the facility. There are no guns or weapons in the facility as stated by PA Escobedo. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. LPA Meza-Gonzalez interviewed three out of ten staff. Last emergency drill was held on October 31, 2021. Due to time constraints, the annual inspection is being extended to inspect and review emergency interventions and staff files. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 will be emailed to PA Escobedo due to printer malfunction.


summary: Facility Evaluation

raw_content:
Narrative:
On May 23, 2022, at 11: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced inspection. LPA Meza-Gonzalez met with Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct an annual continuation inspection. The facility operates as an emergency shelter for ambulatory males and females youths ages 12 to 17 years who are homeless or at risk of homelessness. LPA Meza-Gonzalez reviewed nine staff files (see confidential name list, LIC 811, dated May 23, 2022). LPA Meza-Gonzalez observed the files to be complete and in order. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 was emailed to PA Escobedo due to technical difficulties with the printer.


summary: Facility Evaluation

raw_content:
Narrative:
On March 9, 2023, at 9: AM, Licensing Program Analysts (LPAs) Gloria Meza-Gonzalez and LPA Lucero Jauregui conducted an unannounced inspection. LPA Meza-Gonzalez and LPA Jauregui met with Drop- in Center Coordinator (DCC) Maryanne Olmedo, Night Shelter Coordinator (NSC) Taylor Houston, and Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct a required annual inspection. The facility operates as an emergency shelter for ambulatory male and females children ages 12 to 17 years whom are homeless or at risk of homelessness. There were two clients were present at the time of inspection. LPA Meza-Gonzalez and LPA Jauregui inspected the physical plant inside and outside. The facility is two story building. The facility is set up as follows: The first floor is the drop-in day shelter with a TV room, art room, donation room, Case Manager room and a restroom. The drop in shelter is not currently being used due to water damage repairs. The main living area has a living room and four restrooms with two showers, kitchen and sleeping area. The main dorm room/bedroom for clients is arranged so that it sleeps a capacity of seventeen (17) clients divided by gender preference. There is one client per bed. There are multiple bunk beds (8 bunk beds plus one twin bed) available. (Waiver is on file dated 03/04/2014) There is adequate shelf and closet space for client's belongings. The facility also utilizes large chest for each client that exceeds eight cubic feet of drawer space. (Waiver is on file dated 03/04/2014). The bathrooms were clean and in good repair. The hot water in the client bathroom was measured at 105 degrees F which is within regulatory requirements between 105 degrees F to 120 degrees F. The medication is locked up in a locked box in a locked cabinet behind the staff desk. The laundry room has a washer and dryer for client's use. The extra linen is locked in the laundry room. Cleaning supplies is located in a locked cabinet in the living area. The First Aid Kit is located in the staff office and contained all required supplies. The facility's smoke detectors and carbon monoxide were checked and were operable. See LIC809C page LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients in the pantry and the refrigerator. The second floor is for conference room, administration, and clinical offices. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool located on the premises of the facility. There are no guns or weapons in the facility as stated by PA Escobedo. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. Last emergency drill was held on November 1, 2022. LPA Meza-Gonzalez reviewed four client files (see confidential name list, LIC 811, dated March 9, 2023). LPA Meza-Gonzalez observed the files to be complete and in order. LPA Jauregui interviewed two clients. LPA Jauregui reviewed five staff files. LPA Jauregui observed the files to be complete and in order. LPA Jauregui interviewed two staff. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 were given to PA Escobedo.

met_with: Renata Escobedo


summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2024, at 9: AM, Licensing Program Analyst (LPA) Carol Anderson conducted an unannounced inspection required annual inspection. LPA met with Program Administrator (PA) Renatta Escobedo. The facility operates as an emergency shelter for ambulatory children ages 12 to 17 years who are homeless or at risk of homelessness. LPA interviewed two clients and two staff. LPA inspected the physical plant inside and outside. The facility is two story building. The facility is set up as follows: The first floor is the drop-in day shelter with a TV room, art room, donation room, Case Manager room and a restroom. The drop in shelter is not currently being used due to water damage repairs. The main living area has a living room and four restrooms with two showers, kitchen and sleeping area. The main dorm room/bedroom for clients is arranged so that it sleeps a capacity of seventeen (17) clients divided by gender preference. There is one client per bed. There are multiple bunk beds (8 bunk beds plus one twin bed) available. (Waiver is on file dated 03/04/2014) There is adequate shelf and closet space for client's belongings. The facility also utilizes large chest for each client that exceeds eight cubic feet of drawer space. (Waiver is on file dated 03/04/2014). The bathrooms were clean and in good repair. The hot water in the client bathroom was measured at 117 degrees F. The second floor is for conference room, administration, and clinical offices. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool located on the premises of the facility. There are no guns or weapons in the facility as stated by PA Escobedo. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. A review of Guardian on March 5, 2024, indicates that all facility staff associated to the facility had DOJ, FBI, and child abuse index checks clearances. LPA reviewed five client files and five staff files. All necessary forms are in the file. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report were given to PA Escobedo.

met_with: Renetta Escobedo


summary: Facility Evaluation

raw_content:
Narrative:
On June 11, 2024, at 4: PM, Licensing Program Analyst (LPA) Jacob Salem made an unannounced visit to the above facility and met with Renatta Escobido, Program Administrator. Institutions Evaluations Unit monitor (IEU) Christina Bradley was present during the visit. The purpose of the visit was to conduct a collateral investigation regarding a previous placement. LPA conducted one confidential interview with a client. LPA reviewed and received copies of pertinent records. Due to printer malfunction, an exit interview was conducted and a signed copy of this report was emailed to Renatta Escobido, Program Administrator

met_with: Renatta Escobido, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 23, 2024 at, 2:30PM, Licensing Program Analyst (LPA), Carol Anderson, conducted an unannounced Case Management inspection. LPA met with Renatta Escobedo, Program Manager. LPA interviewed Client 1 (C1) regarding a Special Incident Report that was submitted to Community Care Licensing on July 1, 2024. The purpose of the inspections was to interview Client 1 (C1). LPA interviewed C1. No further information required at this time. Due to printer failure, A copy of this report will be emailed to Program Manager Renatta Escobedo.

met_with: Renatta Escobedo, Program Manager