summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on information obtained and interviews, there is a preponderance of evidence to prove that Administrator paid the drug dealer and had knowledge of substance abuse issues regarding clients. Therefore, the allegations, minor engaging in illegal drug activity, are substantiated. The facility is being cited deficiencies per Short-Term Residential Therapeutic Program (STRTP) Health and Safety Code (HSC) 1550 (c). See the attached LIC9099-D for details. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to the Administrator.

Investigation Findings:
13On 3/11/22, LPA Alyssa Ng conducted a complaint inspection with Eagle Eye and spoke with Larry Hickman (Licensee), Derrick Kennedy (Administrator), and Beverly Trent(Facility Manager). The purpose of the inspection was to deliver the findings for the above complaint allegations. This complaint was taken as a complaint by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Megan Mullen on 01/04/2022. During Confidential Interviews by IB Mullen, witnesses stated that the Administrator paid client's marijuana and had knowledge of drug and alcohol. All clients living in the listed facility said that all staff are aware that most of the client's smoke marijuana and drink alcohol and do not get in trouble if it is not on the property. One staff and all six clients stated that clients will go across the street to use substances. All of the clients were under the age of 18 years old. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: 015650084

met_with: Larry Hickman,Derrick Kennedy,Beverly Trent


state: CA

facility_name: EAGLE EYE

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 4/8/2022 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection and spoke with Derrick Kennedy (Administrator). The purpose of the inspection was to open the complaint and deliver the findings for the above complaint allegations. During the course of investigating this allegation, LPA conducted confidential interviews with staff and clients. Confidential interviews reveal that staff cursed at client while in care. Based on LPA's interview with Administrator and record review(s), the preponderance of evidence standard has been met, therefore the above allegation, Staff speaks inappropriate to clients in care is found to be SUBSTANTIATED. The facility is being cited deficiencies per Short-Term Residential Therapeutic Program (STRTP) California Code of Regulations 80072(1) - Personal Rights. See the attached LIC9099-D for details. The Administrator had to leave for a meeting so Facility Manager Beverly Trent signed this report a copy of this report was emailed to the Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: 015650084

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

report_type: Complaint Investigation

met_with: Derrick Kennedy

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
LPA asked the nine staff members, "Do you feel Eagle Eye provides a safe environment for kids?". All Nine staff members responded, "Yes ". LPA asked the five clients, "Have you ever seen a client bullied by staff or other clients?". Four out of five said no, including the client that the Reporting Party was referring to. One did mention that sometimes one client gets "messed with" because he does not follow Covid protocols and other clients feel that he is putting their health and safety at risk. LPA asked the nine staff members, "Have you ever seen a client bullied by staff or other clients?". All nine said that the clients do mess with each other but it's within reason for teenage boys and they do not feel like there is any targeting bullying happening. Most of the staff mentioned that if they see bulling they would stop it immediately. Although the allegations, minor is being bullied while in care and facility does not provide a safe environment for minor in care, may have happened or is valid, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is unsubstantiated. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Derrick Kennedy, Administrator..

Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPA met with Derrick Kennedy, Administrator (ADM) at 11: AM on 4/27/22. During the investigation, LPA Simien conducted confidential interviews with five clients and nine staff members. Clients were interviewed on 2/9/22 and 2/11/22. Staff were interviewed on 2/9/22, 2/11/22, 4/4/22, 4/5/22, 4/7/22, and 4/8/22. LPA Simien reviewed and obtained copies of needs and service plans, staff schedule from 12/1/22-1/31/22, current staff phone list, house notes from 12/1/22-1/31/2022, police report numbers and name of responding officers from 12/1/22-1/31/2. LPA asked the five clients, "Do you feel Eagle Eye provides a safe environment for kids?". Three clients said yes and two clients said no, although one that said no could not explain why they felt that way. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 04/27/2022

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on information obtained and interviews, there is a preponderance of evidence to prove that Minor became intoxicated while in care and Minor has access to alcohol and illegal substances. Therefore, the above allegations, are substantiated. The facility is being cited deficiencies per Short-Term Residential Therapeutic Program (STRTP), Personal Rights 7072. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to the Executive Director.

Investigation Findings:
13On 4/29/22, LPA Isabel Mendoza conducted a complaint inspection with Eagle Eye and met with Larry Hickman (Licensee) at the . The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, LPA's Christopher Rollins and Isabel Mendoza interviewed staff, clients, authorized representatives, legal guardians, and reviewed (C1) (please refer to LIC 811, dated 4/29/22 for confidential names) file, and 01/04/ Community Care Licensing's (CCL's) Investigations Branch (IB) report, control number 14-CR-20220104083818, complaint from 1/4/22. Confidential interviews, interviews revealed that clients became intoxicated while in care, and minor have access to alcohol and illegal substances. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Isabel Mendoza LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 04/29/2022

met_with: Larry Hickman-Licensee


raw_content:
Narrative:
They said that a staff member was under the influence of cannabis while driving them. Both witness highlighted that the staff member was driving unsafely as the main reason why they felt the staff was under the influence of cannabis. LPA asked the nine staff members, "Have you ever observed or know of a Staff member being intoxicated or 'high' while on duty?" All nine said either "no" or "not sure". All nine staff members mentioned that they did not physically see it. Some mentioned they only heard about it from some of the clients. One staff member claimed that the allegation is false. They said a staff member was never under the influence around clients. LPA Simien followed up with the question, "why would clients come together and make this up?" The staff member said that the clients made up the story to get back at this staff member because they don't like them because they enforce the rules. The staff member said that the clients are roommates and have an agenda against that staff member. On 5/18/ Riverside County Investigator contacted LPA Simien to discuss above listed complaint. The Investigator explained that he was investigating the same complaint. During the discussion it was discovered that one of the clients who told LPA Simien they saw a staff member under the influence of a substance told the Investigator that have never seen a staff member under the influence of a substance. The two statements the client made contradicts each other. Although the allegations, staff transported minor while under influence of a substance, may have happened or is valid, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is unsubstantiated. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Adrian Peebles, Administrator .

Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPA met with Adrian Peebles, Administrator (ADM) at 10: AM on 6/24/22. During the investigation, LPA Simien conducted confidential interviews with 14 witnesses.They were interviewed on 2/9/22, 2/11/22, 4/4/22, 4/5/22, 4/7/22, and 4/8/22. LPA Simien reviewed and obtained copies of needs and service plans, staff schedule from 12/1/22-1/31/22, current staff phone list, house notes from 12/1/22-1/31/2022, police report numbers and name of responding officers from 12/1/22-1/31/22. LPA asked the five witnesses, "Have you ever observed or know of a Staff member being intoxicated or 'high' while on duty?" Three witnesses responded "no". Two witnesses said "yes". UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 06/24/2022

met_with: Adrian Peebles, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
On 8/1/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Adrian Peebles, Administrator and Larry Hickman, Licensee. The purpose of the inspection was to deliver the findings for the above complaint allegation. During Investigation, confidential interviews were conducted and needs and services plans reveal that facility followed procedure when discharging C1 (See LIC 811, dated 7/22/22). C1's reason for discharge was environmental alternatives and refusal of COVID vaccination. All parties confirmed that C1 was adamant on not receiving the COVID vaccination but since Eagle Eye is in Oakland, Oakland Unified School District require all students to be vaccinated. C1's Social Worker and the facility was in contact with the Education Liaison during this time. C1 grew up in a more rural area and both the facility and C1's Social Worker felt that Oakland was not the right environment for him. To add to this, an incident with C1 and C2 occurred. C2 reported to staff that C1 touched him inappropriately and felt uncomfortable. C2 was moved downstairs and was on enhanced supervision. Although the allegation may have happened or is valid, there is not a preponderance of the evidence of Inappropriate discharge and violation of personal rights, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was sent to Adrian Peebles, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Adrian Peebles and Larry Hickman


raw_content:
Narrative:
Also, in the Program Statement under Handling Money, Personal Property & Valuables Policies, it states, "Allowances are issued to youth on a weekly basis". Based on the confidential interviews with both staff and clients, the facility went back and forth with daily and weekly allowances. LPA Ng explain to Administrator Adrian Peebles that any changes in the Program Statement, must get approved by CCL first. Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 80022(a)(12) Plan of Operation. Refer to 9099D. One deficiency and one technical violation was cited. An exit interview was conducted, appeal rights provided, and given to Adrian Peebles, Administrator.

Investigation Findings:
13On 8/1/22 at 9: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Adrian Peebles, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During confidential interviews and a review of the Program Statement and allowance log, all parties were confused when the allowance is given out. Some said daily and some said weekly. When allowance is given, it was also disclosed to LPA Ng that the amount of allowance is based on their behavior. Staff confirmed that money would be deducted if clients did not follow the house rules that are posted in the facility. In the Program Statement under Positive Discipline Policies, it states, "Any other form of discipline approved in writing, in advance by the licensing agency." There is no mention of reducing client's allowance. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 08/01/2022

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

met_with: Adrian Peebles


raw_content:
Investigation Findings:
13On 8/1/22 at 9: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Adrian Peebles, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During confidential interviews, observations, and a review of facility menu and receipts, facility has sufficient food supply. On 7/15/22 and 7/22/ LPA Ng did a facility walk through and saw that the extra fridge and freezer was stocked with meat and extra food. When interviewing clients and staff, all parties stated that there was enough food and that the facility always maintained their client to staff ratio. LPA Ng reviewed the staff schedule and shift notes and confirmed that staff are providing adequate supervision to clients in care. Although the allegation may have happened or is valid, there is not a preponderance of the evidence that staff do not provide appropriate food services for the minors and staff are not providing adequate supervision, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was sent to Adrian Peebles, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Investigation Findings:
13On 8/1/22 at 9: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Adrian Peebles, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, shift notes and incident reports reveal that staff found alcohol and weed during a room search in C1's (See LIC 811, dated 7/15/22) room. When staff found the empty alcohol bottle, staff notified Administrator, authorized representatives, and sent an incident report to CCL. When staff conduct room searches, staff ensures there are two staff present. When finding contraband, staff remove the contraband and discard it. A staff member checks in with the client and reminds them that the facility is a drug free zone and not allowed. All parties denied seeing C1 drink alcohol and smoke marijuana in the facility. When interviewing clients and staff, everyone stated that there was enough food and that the facility always maintained their client to staff ratio. LPA Ng reviewed shift notes and confirmed that staff are providing adequate supervision to clients in care. Although the allegation may have happened or is valid, there is not a preponderance of the evidence that Minor is drinking alcohol while in care, Minor is smoking marijuana while in care, Facility does not have an adequate amount of food supplies, Meals are not being prepared for minors in care, Minor(s) not being properly supervised while in care, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was sent to Adrian Peebles, Administrator . UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Narrative:
continued from LIC 9099-A needs. Therefore, the allegation is UNSUBSTANTIATED. Regarding the allegation of staff was not responsive to minor's medical concerns: LPA conducted confidential interviews. C1 stated that the facility was meeting all her medical needs and she felt happy with services provided. During confidential interviews with staff, staff 1 states the C1 always has headaches, and declines medical help when offered. Another interview disclosed that other direct care workers do not fulfill the needs of clients. LPA conducted document research in shift notes and found no evidence of staff being unresponsive to C1's medical concerns. C1's initial needs and service plan states that C1 is refusing to take all medications. An incident report dated 9-6-22 states that C1 did not go to school because she was not feeling well and refused medical attention when offered. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff was not responsive to minor's medical concern. Therefore, the allegation is UNSUBSTANTIATED. Regarding the allegation of facility not providing a safe environment for minor: LPA conducted confidential interviews with staff and clients. C1 stated that she feels safe and that all her needs are being met by the facility. Based on confidential interviews it was disclosed that staff pick and choose their favorite clients and that other clients try to trigger other clients off. In addition, it was stated that some direct care workers take long breaks, not supervising clients as closely as they should. LPA conducted document research and found no evidence of unsafe conditions for minors. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that facility does not provide a safe environment for minor. Therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Head of Service. continued from LIC There were phone calls to the facility and there was no response. A school counselor visited C1 at the facility and convinced C1 to return to school. C1 attended school the next day and never returned. The school official stated that the facility did not attempt to meet and address the issues. Based on the information obtained, there is a preponderance of evidence to prove that facility is not ensuring that minor attends school. Therefore, the allegation is SUBSTANTIATED. LPA is issuing a citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 3, Section 87022(f) Plan of Operation and issuing Technical Violation, 87079(a)(5) Planned activities. See attached LIC 9099-D and LIC TV. An exit interview was provided and a copy of this report was given to Derrick Kennedy, Head of Services.

Investigation Findings:
13On 1-6-23 10:56AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced follow up inspection at the Eagle Eye, and met with Derrick Kennedy, Head of Service. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA conducted confidential interviews and document research. During document research, LPA found from school attendance records that C1 missed 38 days of school out of 62 days, unexcused. School representatives state that C1 no longer attends school. LPA conducted confidential interviews. C1 stated that she no longer attends school because she fears for her safety. Students bully and harass her because of her gender identity. LPA interviewed a school official and stated that the school notified the facility via email to address the lack of attendance and safety concerns. Facility responded that they were looking for a new therapist and will address the problem once hired. The school continued to communicate, the facility would refer the school to other facility members, which never responded. continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: 015650084

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

met_with: Derrick Kennedy,Head of Service


raw_content:
Narrative:
continued from LIC LPA is issuing a citation for violation of California Code of Regulations, Title 22, Interim Licensing Standard, Article 6, 87072(c)(10) Personal Rights. LPA issued Technical Assistance of California Code of Regulations, Title 22, Interim Licensing Standard, Article 6, 87065.1(e)(3)(A) Supervision, Evaluation, and Training Requirements. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Derrick Kennedy, Head of Services.

Investigation Findings:
13On 1-6-23 1:07PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced follow up follow up inspection at Eagle Eye, and met with Derrick Kennedy, Head of Service. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of the investigation, LPA conducted confidential interviews with staff, clients, and representatives. Staff, clients and representatives interviewed stated staff often use wrong, or derogatory names to address clients. Many times intentional and sometimes by mistake. Staff admitted that the facility is unable to provide the proper care or training, and other staff stated that staff should be trained in gender affirming/sensitivity training. LPA conducted document research and found in needs and service plans that clients have conflict with staff that do not respect proper pronouns or gender identity. They do not connect well when feeling disrespected. LPA found that staff was dismissive regarding trauma informed care and practices. Based on the information obtained, there is a preponderance of evidence to prove that staff do not treat minor with respect or dignity. Therefore, the allegation is SUBSTANTIATED. continued on LIC9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: 015650084

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

met_with: Derrick Kennedy, Head of Service


raw_content:
Narrative:
continued from LIC Once this information was reported, it was immediately reported to C1's authorized representative. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff allow minor in care to be sexually exploited. Therefore, the allegation is UNSUBSTANTIATED. Regarding the allegation of staff not responsive to school official: During the course of the investigation, LPA conducted confidential interviews and document research. During document research, LPA found from school attendance records that C1 missed 38 days of school out of 62 days, unexcused. Confidential emails from the facility to the school, requested meeting times with the school to address C1's concerns and attendance. LPA conducted confidential interviews and found that school officials contacted Eagle Eye via email and phone calls. School officials stated that it took Eagle Eye days or week to respond regarding C1's concerns. When Eagle Eye would respond, they would refer the school to another staff member, who would never reply back. School officials stated that the facility did not attempt to meet and address the issues. Facility staff stated that the facility was not doing enough to keep improve C1's school attendance. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff are not responsive to school official. Therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Head of Service. .

Investigation Findings:
13On 1-26-23 12:48PM,, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced follow up inspection at the Eagle Eye and met with Derrick Kennedy, Head of Service. The purpose of the inspection was to deliver the findings for the above complaint allegations. Regarding the allegation of staff allow minor in care to be sexually exploited: During the course of the investigation, LPA Karkazis conducted confidential interviews and document research. In document research, LPA found no evidence of C1 involved in high-risk behavior in shift notes and incident reports. C1's needs and service plans state that C1 needs to reduce dangerous behavior that (C1) currently exhibits. During confidential interviews with staff and clients, they stated that they had only suspicions of C1 engaging in high-risk behavior. During confidential interview it was reported that (C1) engages in high risk behaviors and reported this information. However, it is not certain if accurate accounts of the events were provided. continued LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 01/26/2023

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


raw_content:
Narrative:
brandished a knife at school, not consistently going to school, AWOLS, damaging the facility van door. and failure to improve behavior. CQ was informed of the 14-day notice verbally on 4/25/22. LPA looked up the facility incident report (IR) archive and found the knife incident which occurred on 11/27/21, three IRs for missing school (on 5/2/22, 5/3/22, and 5/4/22 which was after 14-day notice), one AWOL (4/23/22), and the van incident (4/27/22, which was two days after verbal 14-day notice). CQ stated they were told on 4/25/22 that they were given a 14-day notice for missing school and AWOLs. CQ stated they were discriminated against because other clients AWOLed, missed school, and do worse things. CQ said stated that they missed some school and got kicked out at their previous school but had been consistently attending their current school. They stated they only missed school this week (the week starting on 4/25/22) due to having a sore throat and not feeling well. Most individuals interviewed said that other clients were also missing school, AWOLing, with some doing worse/more dangerous things than CQs but did not get 14-day notice. When LPA inquired about the knife incident, CQ stated that they brought the knife to school because they felt threaten by another student and needed it for self-defense. When LPA inquired about the van door incident, CQ stated that it was an accident. They said that the Van door was previously broken and hard to close. When they attempted to close it the first time it did not close, so they closed the door with more force to close it which result in the door flying off the hinge and breaking a window. Most individuals interviewed stated that they knew or heard the van door was broken before that incident. LPA asked individuals interviewed if IUM has ever made them sign a training sheet without receiving training. Most answered not remember ever signing a training sheet, with one individual stating if their name was on a training sheet (it was on the sheet) it was forged and another admitting upper management asked them to create fake training sheets and to fill out the signatures. When LPA inquired about training provided by upper management most individuals stated that it was inadequate. LPA requested and received training material for IRs and trauma informed care (TIC). For IR training the facility sent staff training sign in sheet and a Word document that had reporting requirements regulations copied onto it. For TIC the facility sent a one page flyer that gives a brief general explanation of trauma informed care, unsigned LIC 613B (which lists personal rights), and a staff training sign in sheet. The sheet indicated that one of the trainers was upper management and was qualified to conduct this training since they were STRTP Administrator certified (this is not a qualification to be a trainer of TIC). Facility also stated that TIC training included a 30 minute video but didn't list the title so there was no way for LPA to verify the video. Facility did not provide LPA with certification of TIC for staff. LPA asked individuals if there were some staff that could not do the basic duties of the job. Individuals stated at least one or more could not or would not do basic job duties. Some examples given are not providing food and not picking up medicine for clients. Not preforming room checks, watching tv, doing personal Laundry, washing personal car, and falling sleep while on duty allowing clients to AWOL unnoticed. These examples indicate that some staff members did not provide adequate care and supervision. Most individuals indicated that management was aware of this. Based on LPA interviews and records reviewed, the preponderance of evidence standard has been met, therefore the list above allegations, are found to be SUBSTANTIATED. As a result of this visit, there is three General Licensing Standards violations ( Personal Rights(a)(3), Personnel Requirements(a), and Responsibility for Providing Care and Supervision(a)) and one Interim Licensing Standards v.4 87065. Supervision, Evaluation and Training Requirement (c)(5) violation. The facility will be cited (see 809-Ds for details). Appeal rights were discussed and provided to HOS. Exit interview was conducted and a copy of this report was provided to Derrick Kennedy, HOS whose signature on this form confirm receipt of these documents.

Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegations. LPA met with Derrick Kennedy, Head of Service (HOS) at 12: PM on 2/17/23. Over the course of the investigation, LPA conducted confidential interviews and reviewed files during this investigation. Based on confidential interviews conducted it was determined that the allegations listed above are Substantiated. During confidential interviews individuals stated the client in question (CQ) was given a 14-days notice due to retaliation from an individual from upper management (IUM). Individuals stated that the motivation for this was that IUM was retailing against another staff member they were having conflict with. The conflict included verbal/physical incidents, arguments about inadequate services, and "snitching" to CCL. This employee had a strong positive rapport with CQ. Individuals stated that they had witnessed, heard, or experienced retaliations from IUM. IUM was described as confrontational, hostile, and having a "your either with me or against me" attitude. The reasons given from the facility for the 14-day notice was an indicdent where CQ SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 02/17/2023

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


raw_content:
Narrative:
The complaint allegations, minors had sexual activities in the facility without supervision, are valid because the preponderance of the evidence standard has been met, therefore the allegation is substantiated. As a result of this visit, there is one title Regulation and General Licensing Standards Responsibility for Providing Care and Supervision (a) violation observed. The facility will be cited (see LIC 9099-D for details). Appeal rights were discussed and provided. Exit interview was conducted and a copy of this report was provided to Adrian Peebles, Administrator whose signature on this form confirm receipt of these documents.

Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegation, investigated by the Investigation Branch (IB). LPA discussed findings with Adrian Peebles, Administrator on 6/24/22 at 10: AM. On 3/16/ San Jose Children's Residential Regional Office (RO) received above complaint and referred it to IB. On 3/25/ LPA Madeleine Fremont opened an initial 10-day visit at above listed facility and requested the following documents: Needs and Services Plans for all clients in care, LIC 500, Client roster, incident reports from October 2021, November 2021, December 2021, incident reporting policy. On 3/17/ IB Investigator Jorge Mendez was assigned to investigate above listed allegation. Based on IB Investigator Mendez's confidential interviews conducted 4/5/22-6/10/22. There was evidence of above allegations occurring. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 06/23/2022

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


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Christopher Rollins made an unannounced annual required inspection to Eagle Eye Short Term Residential Therapeutic Program (STRTP). LPA met with Derrick Kennedy Administrator and inspect the facility inside and out. The STRTP is licensed to served 6 clients ages 13-17 and non minor dependents. Present during the inspection there were 2 staff and 1 client. The facility consists of four bedrooms (3 for clients and 1 for storage) and 2 1/ Bathrooms (1/2 for Staff and 2 for clients). The facility is a two story home with a side office. The facility is licensed for 6 residents and currently 6 clients reside in facility. No more than two clients share a bedroom. At 11: AM, LPA and Administrator conducted a walk through of the facility and office. LPA observed the kitchen to be clean. The hot water in the bathroom, shower and kitchen measured 110 degrees F which is currently between 105 - 120 degrees. The facility has plenty of nonperishable and perishable food supply. Medication, knives and cleaning supplies is locked away. There are enough folks, spoons, plates and cups. All passageways are unobstructed. All smoke detectors are update and working. The home is clean, safe, and sanitary. There are no firearms on the property. The fire extinguisher has been checked and is up to date. There are no bodies of water on the property. The home is maintained at a comfortable temperature. Personal rights, floor plan, food menu and Emergency disaster forms were posted and in clear view. At 12: PM, LPA reviewed five clients files with Administrator. Administrator notified LPA that one client was accepted in on 9/8/21 and Administrator is still putting together his file. LPA observed all five client files to be complete and found no deficiencies. LPA observed medication log to be up to date and complete. At 1: PM, LPA reviewed seven staff files with Administrator. LPA observed all seven staff files to be complete and found no deficiencies. LPA observed all staff files to have the correct up to date documentation and all staff were up to date with their staff training for the year. At 2: PM, LPA conducted 2 staff Interviews and 2 client interviews. During inspection, LPA receive an updated copy of the LIC Personnel Report and updated client list to maintain their file current. A review of Licensing Information System on September 9, 2021 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. Per Title Regulations, no deficiencies were cited during the inspection. Exit interview was conducted and a copy of the report was left at the facility.

report_type: Facility Evaluation

visit_type: Annual

met_with: Derrick Kennedy-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 8/1/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted an unannounced case management inspection with Eagle Eye and spoke with Adrian Peebles (ADM), Administrator and Larry Hickman (LIC), Licensee. The purpose of the inspection was to follow up on food requirements and an incident involving clients bringing in contraband in the facility. LPA Ng and George Karkazis went to listed facility on 7/15/22 and 7/22/22 to open complaints and observed the main fridge having little to no fresh produce. LPAs saw one stalk of celery and leftovers in the fridge. On the kitchen counter, LPA observed the fruit bowl to have bananas, chips, cookies, and apples. When inspecting the extra fridge and freezer upstairs, LPA's saw no fresh produce. LPA Ng also reviewed recent receipts and saw that there was one purchase of broccoli and the rest was frozen foods, meat, and some fruits. LPA Ng let ADM know that this did not meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan. During confidential interviews with clients and staff, all parties disclosed that it was easy to bring in contraband after an outing, approved pass, and coming back from an AWOL or community walk. All parties stated that there is no search conducted, perform room checks a few times a week and will confiscate contraband if found. LPA Ng reviewed incident reports and saw that there is a pattern contraband being brought in. LPA Ng and name, title discussed different techniques to try and prevent/reduce the times clients are bringing in contraband. ---Cont. ON 9099-C ------------- ADM and LIC brainstormed and came to the conclusion that informing youth about their rights and bag searches. ADM will hold a meeting with staff in regards to establishing house rules and informing/requesting bag searches when coming back from an outing. A technical was given for violation of California Code of Regulations, Title 22, Division Six, Section 80076(a)(1) Food Services An exit interview was conducted, appeal rights provided, and given to Adrian Peebles, Administrator.

visit_type: Case Management

met_with: Adrian Peebles, Larry Hickman


summary: Facility Evaluation

raw_content:
Narrative:
On 9-21-22 at 10:00AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced case management inspection. The purpose of the inspection was to obtain additional information regarding an incident that occurred on 9-20-22 approximately, 12: AM between two clients C1 and C3. The facility notified LPA Karkazis via phone on 9-21-22 at 8:35AM. The overnight staff discovered the two clients locked in the bathroom together. At this time, further information is needed to resolve this incident. LPA Karkazis requested the facility to submit an incident report no later than Friday 9-23-22.


summary: Facility Evaluation

raw_content:
Narrative:
On 11-4-22 2:16PM, Licensing Program Analyst (LPA) met with Beverly Trent and Derrick Kennedy, Facility Manager. The purpose of the visit was to conduct interviews for complaint 14-CR-20221026163257, and to inspect the facility. Present were six clients and three staff. Two clients and two staff interviews were conducted. LPA Karkazis and Beverly Trent toured the facility. Clients and staff were interacting amicably. Clients were having snacks and cooking in the kitchen. There was a seven day supply of non-perishable food and a two day supply of perishable food present. The facility was clean and in good repair. During confidential interviews it was stated that the facility will be tentatively moving to the San Rafael area 11-7-22, next week. LPA Karkazis notified Facility Manager Derrick Kennedy the following regarding the move: *What is the plan for your clients? *Have notified all authorized representatives? *What date will you officially close the Oakland facility? *Please send Oakland license once you have closed. LPA Karkazis has advised Derrick Kennedy and staff to provide this information as soon as possible, to George.Karkazis@dss.ca.gov An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Facility Manager.

met_with: Derrick Kennedy, Facility Manager, Beverly Trent Care Worker


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst's (LPA) Shikya Belfield and LPA Paul Simien made an unannounced case management inspection at the above facility on 2/9/2022 at 10: AM. The purpose for this inspection is to conduct a case management regarding an incident report the that was received by the department. The incident report involved a runaway report for C1 (see lic 811 dated 2/9/2022). LPA discussed the with administrator that the reports were not submitted within the required time frame and the report was missing information regarding the incident. This report also provides information for multiple events that were not provided to the department when they occurred. Facility cited for violation of section 80061(b) Reporting Requirements. During a review of client files, LPA attempted to review C1's file and the file could not be located. All other client files were present in the facility however, C1's file was not able to be located by staff and they did not know where it was. Facility cited for violation of section 80070(a) Client Records. LPA Belfield requested all Incident reports from December 2021 and January 2022. During this inspection a walk through was conducted of the facility with facility manager Beverly Trent. During the walk-through LPA observed client bedrooms and bathroom on two floors. First client bedroom on the first floor had broken blinds and no screen on the window, LPA observed the screens outside the windows on the ground. Also observed during the walk-through were holes in the wall in the second floor bathroom and hallway. Currently there are repairs being done to the facility and the holes, along with all other repairs will be completed by 2/18/2022. Advisory issued. LPA discussed adding more storage to client's rooms for clothing. Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 80061(b) Reporting Requirements and section 80070(a) Client Records. Advisory Note issued regarding repairs.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst's (LPA) Alyssa Ng and Shikya Belfield, made an unannounced case management inspection at the above facility on 3/11/2022 at 10: AM. The purpose for this inspection is to conduct a case management regarding incidents involving law enforcement, that were not reported to the department. Program Director Larry Hickman and administrator Derrick Kennedy assisted with the inspection. On 2/9/ LPA Belfield and LPA Simeon discussed with the administrator Derrick Kennedy during a case management inspection, that all incident reports from December 1, 2021 to January 2022 needed to be submitted to the department for review. The administrator informed LPA's Belfield and Simeon on 2/18/2022 and 2/23/22 via email and follow up phone call, that there were no incidents that took place from December 1, 2021 to January 31, 2022 outside of a run away report that was submitted in January 2022 with C1 (see Lic 811 dated 3/11/2022). Based on a review of communication logs submitted on 2/18/2022 by the administrator, C3 was in the hospital for approximately one month and no report was submitted to the department regarding the incident or the reason for hospitalization. This incident report was submitted to LPA Belfield by the administrator via email on 2/23/2022 after a phone discussion. A call log report obtained by Law Enforcement ( Oakland Police Department) displays 18 calls of service to the facility from 12/1/21 to 1/31/2022. LPA asked the administrator why none this incidents were reported to the department. Administrator stated that they need to talk to the staff to determine the reason for reports not being submitted. During this inspection it was stated by program director that the administrator is responsible for writing all incident reports. Facility cited for violation of section 80061(b) Reporting Requirements. During the inspection on 2/9/ LPA Belfield requested and reviewed client files. There were no files present in the facility for clients C1 and C2. LPA requested these files and they were not available for review. Based on email communication with director Larry Hickman, these files would be submitted to the department. The files for C1 and C2 have not been received for review. During this inspection LPA requested the files for C1 and C2, staff Trent was able to provide the client files for review by LPA Belfield. Although some client information was available, the client file was incomplete as documents were missing. During a review of the file of C1, it was observed by LPA Belfield that C1's medication log was signed off by staff as meds given and during this time the client was on runaway status and not at the facility to receive medication. Facility cited for violation of Section 80070(a) Client records. Facility cited for violation of California Code of Regulations, Title 22, Division Six / Interim Licensing Standards, Section 80070(a) client records and 80061(b). An exit interview was conducted. A copy of this report along with appeal rights will be sent to the administrator Derrick Kennedy and licensee Larry Hickman.

met_with: Larry Hickman


facility_name: EAGLE EYE-HORIZONS

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Investigation Findings:
13This document has been amended due to an appeal of the citations that were issued and the appeal has been granted. The citations have been removed and the visit summary is revised as follows: On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Alexandra Karagosian and Kaleybra Block regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the home, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegation, and although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that Staff did not report incident to appropriate parties; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli 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 Citations on this Visit Report are Under Appeal! Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SANTA ROSA RO, NEOTOMAS AVENUE, STE. FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: 216890092

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

met_with: Shallen So'Brien


raw_content:
Investigation Findings:
13This document has been amended due to an appeal of the citations that were issued and the appeal has been granted. The citations have been removed and the visit summary is revised as follows: On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Social Worker Shallen So'Brien regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the home, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegation, and although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that Facility staff allows minors to engage in inappropriate activities; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli 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 Citations on this Visit Report are Under Appeal! Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SANTA ROSA RO, NEOTOMAS AVENUE, STE. FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: 216890092

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


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karangosia, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. The census was 5 youth (amended version would not update census). During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Due to lack of supervision, minor eloped from the facility, or Due to lack of supervision, minors engaged in inapropriate activites, or Staff do not prevent minors from bulling other minors in the home; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Alexandra Karangosia


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Minors use marijuana and drink alcohol on the premises; Minors smoke on the premises; Minor jumped from the second story which resulted in injuries; Minor's medical needs are not being met; Staff did not comply with minor's court order; and Staff did not provide a safe and comfortable environment for minors; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Alexandra Karagosian


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Due to lack of supervision, minor was assaulted by other minors in the home; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Facility staff does not ensure that youth is transported to school while in care; and Facility staff does not ensure that youths are adequately fed while in care; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian and Mental Health Rehab Specialist Mona Mokri, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegation occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Staff do not intervene with physical altercations between minors; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Alexandra Karagosian and Mona Mokri


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegation occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Facility staff does not provide adequate supervision to the minors in care; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Staff allow minors to smoke marijuana, and Staff speak with minors in an inappropriate manner.; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Facility is operating out of ratio, and Minors' hygiene needs are not being met; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Facility staff do not ensure that youths are fed while in care, Facility staff do not ensure facility is kept clean, Staff do not ensure that youths attend school on a regular basis, Untrained staff providing supervision to minors in care, and Facility staff did not provide clothing to youth in care; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analysts (LPA) Brian Bertoli and Nicole del Calvo met with Mental Health Rehab Specialist Som Souksumphhan and Facility Manager Beverly Trent regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Staff do not assist minors with receiving care, Staff do not assist minors with attending school, Staff do not ensure that minors' dietary needs are met, and Staff do not prevent minors from using drugs at the facility; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Som Souksumphhan and Beverly Trent


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Administrator Melvyn Mahon and Mental Health Rehab Specialist Som Souksumphhan regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings regarding the above allegations. During the course of the investigation, LPAs Bertoli and del Calvo inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove Staff is violating Personal Rights of youth and Staff did not follow Emergency Intervention Plan; therefore, the above allegations are Unsubstantiated. No deficiencies were cited for this visit. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Melvyn Mahon and Som Souksumphhan


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Facility Manager Eric Stocker regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove a Lack of supervision resulting in inappropriate behaviors between minors, Clients are not provided with a comfortable and safe environment, Staff did not pick up minor from hospital in a timely manner, Staff did not prevent minor from threatening another minor.; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Eric Stocker


raw_content:
Investigation Findings:
On 10-18-24 12:00PM, Licensing Program (LPA) Analyst George Karkazis conducted an unannounced inspection at Eagle Eye Horizons and met with Beverly Trent, Facility Manager, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff handled child in a rough manner. LPA Karkazis conducted confidential interviews, and conducted document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Beverly Trent, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Beverly Trent, Facility Manager


raw_content:
Investigation Findings:
13On 11-1-24 11:15AM, Licensing Program Analysts (LPA) George Karkazis and Brian Bertoli conducted an unannounced inspection at Eagle Eye Horizons and met with Beverly Trent, Facility Manager. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff made inappropriate physical contact with a minor. LPA Karkazis conducted confidential interviews and document research which indicate that staff made inappropriate physical contact with a minor in care. Based on the information obtained, there is a preponderance of evidence to prove the above allegation is SUBSTANTIATED. The facility is being cited for Interim Licensing Standards, Article 6, Personal Rights 87072(c)(1), Type A. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Beverly Trent, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis 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 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: 216890092

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


raw_content:
Investigation Findings:
13On 11-8-24 11:15AM, Licensing Program Analysts (LPA) George Karkazis and Brian Bertoli conducted an unannounced inspection at Eagle Eye Horizons and met with Som Souksumphan, MHRS, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff did not seek timely medical attention for a minor and staff did not provide adequate care and supervision of a minor. LPA Karkazis conducted confidential interviews and document research, in which inconsistent information was provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Som Souksumphan, MHRS. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Som Souksumphan, MHRS


raw_content:
Investigation Findings:
13On 11-8-24 11:15PM, Licensing Program Analysts (LPA) George Karkazis and Brian Bertoli conducted an unannounced inspection at Eagle Eye Horizons and met with Som Souksumphan, MHRS, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff did not prevent minors from becoming intoxicated while in care. LPA Karkazis conducted confidential interviews and document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Som Souksumphan, MHRS. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit and met with Mental Health Rehabilitation Specialist Som Souksumphhan at the facility. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of the investigation, the LPA inspected the facility, reviewed records and conducted confidential interviews. It was confirmed that the overnight staff had been sleeping during the shift and that the facility is not following their Program Statement regarding room checks. Based on the information obtained, there is a preponderance of the evidence to prove that the allegations occurred. Therefore, the above allegations are substantiated. Title 22 deficiencies were cited and Appeal Rights were provided and discussed. An exit interview was conducted, and a copy of the report was given to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli 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 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SANTA ROSA RO, NEOTOMAS AVENUE, STE. FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: 216890092

met_with: Som Souksumphhan


summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation staff did not prevent a physical altercation between children resulting in a child's injuries is found to be SUBSTANTIATED. LPA is issuing citations of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section 87065.2 (b)(1) Personal Duties. During the investigation, LPA identified an area in which a Technical Assistance maybe beneficial in ensuring the safety of the residents in care. LPA is issuing an advisory for Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section 87065.2 (b)(7) Personal Duties. An exit interview was conducted, appeal rights provided, and a copy of this report left with (MHRS) Souksumphan.

Investigation Findings:
13On 12/11/24, Licensing Program Analyst (LPA) Celeste Aparicio made an unannounced inspection to the facility for the purpose of delivering findings from a complaint investigation. LPA met with met with Mental Health Residential Specialist (MHRS), Som Souksumphan and spoke with Administrator, Derrick Kennedy over the phone and informed of the purpose of the visit. The complaint alleged that staff did not prevent a physical altercation between children resulting in a child's injuries. Based on confidential interviews, observation, and record review, the following was found. On 10/5/24 a physical altercation occurred at the Vista facility which resulted in two clients' injuries. Before the physical altercation, two Vista residents appeared at the Horizons facility unannounced. Staff at Horizons was aware of the conflicts between the residents and did not allow the Vista residents to enter, however, staff did not communicate the Vista resident's presence at Horizon facility to Vista staff. There had been no internal communication between staff on shift at either facility on 10/5/24 regarding the resident's whereabouts, therefore, staff did not prevent the physical altercation that occurred. (Report continued on LIC9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Celeste Aparicio 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 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: VISIT DATE: 12/11/2024

Deficiencies:
87065.2: (1) Supervision, protection, and care of children at all times, individually and in groups.

met_with: MHRS, Som Souksumphan

title:
Personal Duties
(b)Direct care staff shall perform the following duties


raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation staff providing an unsafe environment to clients in care is found to be SUBSTANTIATED. LPA is issuing citations of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section 87072(c)(1) Personal Rights An exit interview was conducted, appeal rights provided, and a copy of this report left with (MHRS) Souksumphan.

Investigation Findings:
13On 12/11/24, Licensing Program Analyst (LPA) Celeste Aparicio made an unannounced inspection to the facility for the purpose of delivering findings from a complaint investigation. LPA met with met with Mental Health Residential Specialist (MHRS), Som Souksumphan and and spoke with Administrator, Derrick Kennedy over the phone and informed of the purpose of the visit. The Department received a complaint alleging staff providing an unsafe environment to clients in care. Based on confidential interviews it was found that there was a verbal altercation between S1 (see LIC811) and the facility's transportation service aid on 10/15/24.Confidential interviews disclosed that S1 was yelling and being aggressive towards transportation aid. S1 was found to not utilize trauma informed practices to resolve a conflict with the transportation aid. (Report continued on LIC9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Celeste Aparicio 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 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: VISIT DATE: 12/11/2024


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

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

met_with: Direct Care Staff, Jenny Chung


met_with: Facility Manager, Beverly Trent

investigation_findings: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

allegations: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:


summary: Facility Evaluation

raw_content:
Narrative:
On February 22, 2022 at 9:30am, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Larry Hickman, Administrator. This Short-Term Residential Therapeutic Program is a two story facility located in a residential area. The facility consists of 3 client bedrooms and 2 client bathrooms, living and dining areas, recreational room, kitchen, and office. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Fire arms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors/carbon monoxide detectors are throughout the house and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 150 degrees Fahrenheit and hot water heater was turned down during LPA inspection. Staff and client records will be stored and locked on site. Medications will be centrally stored and locked on site. Disinfectants and other toxic materials will be locked in the garage. Extra bedding and towels are kept unlocked, in the hallway closet. Knives and sharps will be kept locked in the garage. Head of Services (HOS) for this location is Derrick Kennedy. The following items are needed for licensure and pictures will be sent to LPA: - kitchen items arriving (plates, cups, pots/pans) - hot water temperature to read between 105 - 120 degrees Fahrenheit - loose boards will be removed from back and side yard - Board Resolution/Board Minutes, in writing, of changing population age to be served Component II: LPA Pavia discussed with the following, with Administrator: - Administrator on site required hours - facility core services and support - facility emergency intervention plan

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On 5/19/23 11: AM, Licensing Program Analyst Alyssa Ng conducted an unannounced Post Licensing inspection at listed facility. LPA met with Larry Hickman, Administrator and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Short Term Therapeutic Program is licensed to serve six clients. Present during the inspection were two staff and three clients. One client was sleep during the time of the inspection. At 11: AM, LPA Ng observed three bedrooms and three bathrooms. All three bedrooms were double occupancy. Two bathrooms is for clients and the other one is downstairs for staff. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA tested the water temperature and found it to be 118. degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the facility office. The facility is in good repair and clean. LPA Ng interviewed one staff and 1 client. At 11: AM Ng toured the backyard. Backyard had a wooden fence and a basketball hoop. The wooden fence is leaning towards the neighbors yard. Administrator stated that he will speak with the neighbors about the fence and let LPA know. The backyard was in good repair and clean. At 12: PM, LPA Ng reviewed staff and client files. A review of Guardian Background Check System printed on May 19th, 2023 indicated that all facility staff have DOJ, FBI and child abuse index check clearances (CAIC). At this time, 0 deficiencies were cited. An exit interview was conducted and a copy of this report was given to Larry Hickman, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA met with Social Worker Clinician Alexandra Karagosian and toured the facility inside and out. The Short Term Therapeutic Program is licensed to serve six clients. Present during the inspection were two staff and three clients. LPA McCambridge observed three bedrooms and three bathrooms. All three bedrooms were double occupancy. Two bathrooms is for clients and the other one is downstairs for staff. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. The home is maintained at a comfortable temperature. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the facility office. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. LPA Brian Bertoli interviewed 2 staff and 3 client. LPA McCambridge reviewed client files. Files are current and complete with required documents. LPAs McCambridge and Bertoli cited a technical violation for staff files not being readily available. Derrick Kennedy agreed to email three staff files to LPA McCambridge by Friday 2/23/24. LPA McCambridge will review staff files as soon as they are available. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Cheyenne McCambridge reviewed staff files that were emailed on 2/23/24. Staff files were reviewed and are current and complete with required documents. LPA went out to the facility and met with Social Worker Clinician Alexandra Karagosian for a signature. A copy of the report was sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Agency Social Worker Alexandra Karagosian. While conducting an inspection, it was determined that the water temperature was at 140 degrees. The facility has been recently cited for high water temperature, but it was confirmed by LPA that the temperature gauge on the water heater showed that it was within acceptable range. While LPA was present, the water heater was adjusted to a lower setting. Per discussion with LPM Diego, LPA is issuing an advisory note for Section Furniture, Fixtures, Equipment, and Supplies (e)(1). An exit interview was conducted and a copy of this report was given to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and George Karkasis made an unannounced visit to the facility and met with Mental Health Rehab Specialist Som Souksumphhan and Facility Manager Beverly Trent. The purpose of the visit was to review information on an incident report dated 10/27/24 in which a runaway youth was not reported by staff. LPAs inspected the facility and conducted confidential interviews. No deficiencies were cited as part of this inspection. An exit interview was conducted and a copy of this report was given to the facility.