summary: Facility Evaluation

raw_content:
Narrative:
On August 15, 2025 at 10:50am, Licensing Program Analysts (LPAs) Rachel Vanegas, Carissa Aviles and Valerie Wilson completed a pre-licensing inspection of Hope Haven Small Family Home (SFH). LPAs met with the Applicant - Mayra Gaona who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a one story building with five bedrooms and four bathrooms which are set up as follows: Bedroom #1 (Applicant's Child) has one single bed and sleeps the applicant's child. The room is locked and inaccessible to client's in care. Bedroom #2 (Master) has one bed and one bathroom and sleeps the applicant and spouse. The room is locked and inaccessible to client's in care. Bedroom #3 (Applicant's Child) has one single bed and sleeps the applicant's child. The room is locked and inaccessible to client's in care. Bedroom #4 (Clients) has one bed will sleep one client. Bedroom #5 (Clients) has two single beds and will sleep two clients. There is also a great room/living room, kitchen, dining area, four bathrooms, a locked laundry room, garage, and the backyard. There is a properly secure electric fire place in the living room. The client's bedroom is arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. *Continued on the next page* There was adequate closet space for the client's belongings. There was a combo/smoke detector in every bedroom and hallway. The combo carbon/smoke detectors were checked and they were working properly. The home's central air conditioning module was located on the backyard. The home appliances were in working order at the time of this inspection. The client and staff files will be in the locked laundry room. There was adequate food storage space. LPAs observed a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste was present in the kitchen. All sharp knives are securely stored in the locked laundry room, inaccessible to clients. The medications will be located in a cabinet in the locked laundry room. Cleaning chemicals and laundry detergent are located in cabinet under the sink in the locked laundry room. The hot water in the kitchen was measured and registered at 112.8 degrees Fahrenheit. The home's tankless hot water heater is located in the garage and set at 119 degress Fahrenheit. The home's first aid kit was accessible and is located in the kitchen and contained all required supplies. There are four fire extinguishers present in the home. Two are located in the kitchen and two are located in the garage. They were observed to be properly charged and inspected by the fire department. There is one firearm in a secured safe located in the master bedroom, which is locked and inaccessible to clients in care. The ammunition is stored in a separate safe in the applicant's locked master bedroom closet, separate from the firearm. There is no pool at the home at the time of this inspection. There is one above ground hot tub. The hot tub is properly secured with a latched hard cover that is securely locked and has appropriate latches along the perimeter of the cover. The backyard where clients will have access to play is fenced. There are three large storage containers located on the property that are securely stored and inaccessible to clients in care. The home has an enclosed farm in the backyard which is secured and inaccessible to clients. The home has 10 security cameras located on the outside perimeter of the home and 3 security cameras located on the inside of the home. Based on this inspection, there are no corrections needed to be made to the home. Component III was completed during this visit. An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the applicant, Mayra Gaona. Application will be forwarded to the Licensing Program Manager for Licensing.


state: CA

facility_name: HOPE HAVEN

summary: Facility Evaluation

raw_content:
Narrative:
On November 13, 2025 at 01:20PM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at Hope Haven Small Family Home (SFH). LPA met with the Staff/Facility Designee - Elyssa Quinonez who led a tour of the home. The home was toured both inside and out. The home is a one story building with five bedrooms and four bathrooms which are set up as follows: Bedroom #1 (Licensee's Child) has one single bed and sleeps the Licensee's child. The room is locked and inaccessible to client's in care. Bedroom #2 (Master) has one bed and one bathroom and sleeps the Licensee and spouse. The room is locked and inaccessible to client's in care. Bedroom #3 (Clients) has two single beds and will sleep two clients. Both beds are vacant at the time of this visit. Bedroom #4 (Licensee's Child) has one single bed and sleeps the Licensee's child. The room is locked and inaccessible to client's in care Bedroom #5 (Clients) has one bed and sleeps one client. There is also a great room/living room, kitchen, dining area, four bathrooms, a locked laundry room, garage, and the backyard. There is a properly secure electric fire place in the living room. The client bedrooms are arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. **Continued on the next page** There was adequate closet space for the client's belongings. There are combo/smoke and carbon detectors in every bedroom and hallway. The combo carbon/smoke detectors were checked and they were working properly. The home's central air conditioning module was located on the backyard. The home appliances were in working order at the time of this inspection. The client and staff files are stored in the locked laundry room. LPA observed a two day supply of perishable and a seven day supply of non-perishable food. Sharp knives, cleaning chemicals, medications, and laundry detergent are securely stored in the locked laundry room, inaccessible to clients. The hot water in the kitchen was measured and registered at 113.3 degrees Fahrenheit. The home's tankless water heater is located in the garage and set at 120 degress Fahrenheit. The home's first aid kit was accessible and is located in the kitchen and contained all required supplies. There are four fire extinguishers present in the home. Two are located in the kitchen and two are located in the garage. They were observed to be properly charged and inspected by the fire department. There is one firearm in a secured safe located in the master bedroom, which is locked and inaccessible to clients in care. The ammunition is stored in a separate safe in the Licensee's locked master bedroom closet, separate from the firearm. There is one above ground hot tub. The hot tub is properly secured with a latched hard cover that is securely locked and has appropriate latches along the perimeter of the cover. The backyard where clients have access to play is fenced. There are three large storage containers located on the property that are inaccessible to clients in care. The home has an enclosed farm in the backyard which is secured and inaccessible to clients. The home has 10 security cameras located on the outside perimeter of the home and 3 security cameras located on the inside of the home (one in the living room, one in the hallway near the garage, one in the hallway near the master bedroom). LPA reviewed three staff files for Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3). LPA observed required documents including CPR/First Aid certificates, Drivers License, Criminal Background Clearance Forms, documentation/verification of tuberculosis (TB) screening, etc. S1, S2, and S3 files did not contain duties of the employee. LPA reviewed one client file for Client 1 (C1). LPA observed required documents including signed placement agreements, Authorization of Medical Care Form signed by the Authorized Representative, etc. Client file for C1 did not contain a signed Personal Rights Form (LIC 613B). **Continued on the next page** Based on observation and record review, the facility is issued two Technical Violations in accordance with California Code of Regulations (CCR) Section 83070(b)(13) for not having a signed acknowledgment of Personal Rights signed by the authorized representative and client on file and CCR Section 80066(a)(8) for not having duties of employees included in staff files (S1, S2, and S3). An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the Staff/Facility Designee - Elyssa Quinonez.

report_type: Facility Evaluation

met_with: Staff - Elyssa Quinonez


summary: Facility Evaluation

raw_content:
Narrative:
On January 16, 2026, Licensing Program Analyst (LPA), Val Wilson met with Licensee, Mayra Goana, at Hope Haven Small Family Home (SFH) for the purpose of conducting a Case Management inspection visit regarding the Plan of Operation (POO). On November 25, 2025, CCL was made aware by the Licensee via phone call that the C1 would be turning 18 in January 2026. LPA Rachel Vanegas provided the Licensee with AB12 regulatory information to assist the Licensee with required Program Statement (PS) revisions. LPA Vanegas informed the Licensee that an updated LIC 200 and Program Statement would need to be completed, submitted and approved to include the Nonminor Dependents population on the facility license. LPA further informed the Licensee that the aforementioned should be submitted at least 30 days prior to the client turning 18 years old. On December 22, 2025, the Licensee notified CCL via email that C1 will be 18 years of age on January 8, 2026, and San Diego County approved extending care in the SFH. The Licensee acknowledged LPA Rachel Vanegas had indicated the PS would need Nonminor dependent additions reviewed for approval prior to Nonminor dependent placement. The Licensee indicated via email that they hoped to have the documents submitted by the end of the week. On January12, 2026, the Licensee submitted the LIC 200 and revised PS to CCL for review and approval to add the Nonminor dependent population to their program. **Continued on page 2** **Continued from page 1** On January 16, 2026, LPA reviewed facility files and observed C1 is residing in the SFH and the Licensee's POO has not been approved for Nonminor dependents. Based on interviews, record review and observation, the Licensee is being cited one Technical violation in accordance with California Code of Regulations (Title 22, Division 6) (CCR) Section 80022 (k) Plan of Operation for not operating in accordance with the terms specified in the facility Plan of Operation. An exit interview was conducted, a copy of this report, LIC 809TV, LIC 809G, LIC 811, and appeal rights were reviewed and provided to the Licensee.

visit_type: Case Management

met_with: Mayra Gaona


facility_name: HORIZON OF BRIGHTER DAYS

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During the investigation, there was no corroborating evidence to support the above allegations, and the confidential interviews revealed conflicting statements to if the incidents occurred. Based on conflicting confidential interviews, the allegations that LI physically abused C1 and an LI spoke to C1 in an inappropriate manner, may have occurred, however, is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were provided to Licensee, Demetrius Williams.

Investigation Findings:
13On April 17, 2025, at 10: AM, Licensing Program Analyst (LPA) Sarah Lo met with Horizon of Brighter Days Small Family Home (SFH), Licensee, Maxine Williams, to deliver the finding for the above-stated allegations. On 01/16/25, LPA Adaleyci Caballero inspected the SFH, and no immediate health and safety hazards were observed. The investigation included interviews with Licensee (LI), Adults (AD1, AD2), Foster Children (C1, C2), and County Social Worker (CSW). In addition, Foster Children's Needs and Services Plans and case notes and County Investigation Narrative were reviewed. On January 10, 2025, Community Care Licensing received a complaint alleging that an adult (LI) physically abused minor (C1) and an adult (LI) spoke to minor (C1) in an inappropriate manner. Specifically, it was reported that LI was upset at C1 for eloping from school and LI called C1 names and LI slapped C1 on the face and dragged C1 by their hair. (continued on LIC 9099c) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Sarah Lo 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: HORIZON OF BRIGHTER DAYSFACILITY NUMBER: VISIT DATE: 04/17/2025

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

report_type: Complaint Investigation

met_with: Licensee, Demetrius Williams

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On March 27, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Demetruis Williams via microsoft teams for a Component II interview. LPA scheduled the pre-licensing inspection with Applicant. A signed copy of this LIC 809 will be placed in the facility file.

met_with: Demetrius Williams


summary: Facility Evaluation

raw_content:
Narrative:
On April 3, 2024 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Horizon of Brighter Days Small Family Home. LPA met with Applicant Demetrius Williams who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement at this time. The home is a one story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed will sleep the applicant. · Bedroom #2 (Client's) has one bed, it will sleep one client. · Bedroom #3 (Client's) has one bed, it will sleep one client. · Bedroom #4 (Client's) has one bed, it will sleep one client. · A great room/living room, kitchen, dining area, three bathrooms, an attached two car garage, laundry room, and the backyard. The Client's bedrooms were arranged so that no more than one client will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The five smoke detectors were checked, and they were working properly. There is one carbon monoxide detector it is located in the hallway. The carbon monoxide detector was checked and it was working properly. The home's central air conditioning module was located on the back porch. The fire place had a glass door covering it. The home phone was not working as Spectrum was out in the area. The home's hot water heater was located in a closet in the hallway made for hot water heaters. The appliances were in working order. The client's files will be kept inside a locked file cabinet in the play room. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked cabinet in the kitchen. The medications are in a locked cabinet in the kitchen. The hot water in the master bathroom measured to be 113.6 degrees Fahrenheit, in bathroom two the hot water measured to be 116 degrees Fahrenheit, and in bathroom 3 the hot water measured to be 114.8 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen and contained all required supplies. One fire extinguisher was present in the home and is located in the pantry. It was observed to be properly charged and inspected by the fire department. Licensee stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play was completely fenced. The following corrections needs to be made: · the home phone needs to be working and available. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing. A component 3 was conducted at 10: AM.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On May 19, 2025 at 10:55AM, Licensing Program Analyst (LPA) Rachel Vanegas completed a post-licensing/annual inspection at Horizon of Brighter Days Small Family Home. LPA met with the Licensee, Demetrius Williams who led a tour of the home. The facility was toured both inside and out. The home is a one story building with four bedrooms and three bathrooms that are arranged as follows: Bedroom #1 (Master) has one bed and sleeps the Licensee and spouse. Bedroom #2 (Client's) has one bed and sleeps one youth. Bedroom #3 (Client's) has one bed and will sleep one youth. It is currently vacant. Bedroom #4 (Client's) has one bed and will sleep one youth. It is currently vacant. A living room, kitchen, dining area, three bathrooms, an attached locked two car garage, laundry room that remains locked and inaccessible to youth in care where cleaning chemicals are securely stored, and the backyard. All bedrooms have adequate storage space for personal belongings in drawers and closets. All bedrooms are arranged so that no more than one client is in one room and there is one client per bed. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There are smoke detectors in every bedroom that were checked and in properly functioning order. There is one carbon monoxide detector located in the hallway. The carbon monoxide detector was checked and was in properly functioning order. There is a fire place in the living room that is properly screened with a glass door covering. The home phone is accessible in the living room to client's in care and in functioning order. **** LPA observed an adequate supply of perishable and non-perishable foods and a posted meal menu in the kitchen. There was a trash can for storage of solid waste with a tight-fitting lid located in the kitchen. LPA observed required postings in the living room hallway including the facility license, foster youth personal rights, Complaint Hotline, etc. There is one fire extinguisher in the home that was observed to be properly charged. It is located in the kitchen pantry. The hot water temperature was checked in the kitchen and registered at 113.5 degrees Fahrenheit. The facility's first aid kit is stored in a kitchen cabinet and contained all of the required materials. The client medications are securely stored in a locked cabinet in the kitchen and refrigerated medication are stored in a lock box in the refrigerator. The facility outside grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water at the facility. There are no fire arms or weapons on the facility grounds as stated by the Licensee. LPA conducted one client file review for Client 1 (C1) and observed necessary documents in the files including, consent to medical treatment authorization forms, placement agreements, signed personal rights form, documented results of tuberculosis (TB) screening, Needs and Services Plan, etc. LPA conducted two staff file reviews for Staff 1 (S1) and Staff 2 (S2). LPA observed that two out of two staff files contained necessary documents including CPR/First Aid certificates, Drivers License, Job Duties, Health Screening, etc. Based on observation and record review, there are no deficiencies cited at this time. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the Licensee - Demetrius Williams.

visit_type: Annual

met_with: Licensee - Demetrius Williams


summary: Facility Evaluation

raw_content:
Narrative:
On January 16, 2025, at 9:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Horizon of Brighter Days Licensee Demetrius Williams to deliver a case management deficiencies report regarding deficiencies observed during an inspection at the SFH on January 16, 2025, for an incident that occurred on or before 01/10/25. Adult (Adult #1 [A1]) residing and/or regularly present in the home without a criminal background check clearance. LPA searched A1 on Guardian and it revealed A1 had a pending criminal record clearance pending since 06/27/24. A1 disclosed that A1 had lost the background check paperwork and went to re-fingerprint on 01/13/25. Record review revealed A1 did not have a background check which is a violation of Licensing General Licensing Requirements Title Regulations 80019(e)(3) all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing, or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance... Based on record review the facility is cited for violation of General Licensing Requirements Title Regulations 80019(e)(3) Criminal Record Clearance which poses an immediate Health, Safety risk to children in care. Civil penalties will be assessed. An exit interview was conducted and a copy of this report, LIC811, LIC809D, and appeal rights were provided to Licensee Demetrius Williams via email.

met_with: Licensee-Demetrius Williams


facility_name: HOUSE OF GRACE

summary: Facility Evaluation

raw_content:
Narrative:
On June 3, 2025 at 3:47PM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Grace Damisah for a Component II of the application process. Lpa a. Caballero went over revisions on part portion of the application only due to time restraint. LPA will schedule a virtual Teams Meeting to go over the application's Program Statement. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.

met_with: Applicant- Grace Damisah


summary: Facility Evaluation

raw_content:
Narrative:
On June 11, 2025 at 9:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Grace Damisah for a Component II of the application process. via Microsoft Teams Meeting. Lpa a. Caballero went over revisions of the Program Statement however; due to applicant not having the correct pages of her Program Statement LPA was unable to proceed. LPA will schedule a virtual Teams Meeting to go over the application's Program Statement another day. LPA will send scan a copy of the Program Statement submitted in the application to assist applicant. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On August 27, 2025, Licensing Program Analyst (LPA) Adaleyci Caballero arrived at the Small Family Home (SFH) to conduct a pre-licensing inspection as scheduled with the applicant. Applicant Grace Damisah cancelled the inspection and LPA did not conduct a pre-licensing inspection of the home. No further action required at this time. A copy of this report was provided to applicant Damisah Grace and the original signed copy will be placed in the facility file.

met_with: Applicant-Damisah Grace


summary: Facility Evaluation

raw_content:
Narrative:
On September 10, 2025 at 1:15PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of House of Grace Small Family Home (SFH). LPA met with Applicant Grace Damisah who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two story building with five bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will be utilized for guests. Bedroom #2- (applicant) It consisted of one California King Bed. The bed had linen, comforters, and pillows. It will sleep applicant and husband. Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #4- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #5- It consisted of two single beds. The beds had linen, comforters, and pillows. It sleeps biological daughter. A living room, family room, dining area, kitchen, loft, laundry room and office space, three car garage, backyard, and a pool. The garage will be utilized as storage. The Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies, and House Rules were posted at this time. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The eight smoke detectors combined with the carbon monoxide detectors were checked and working properly. The home's central air conditioning modules were in the backyard. The water heater is located in the garage. The appliances were in working order. Client and staff files will be locked inside a cabinet in the kitchen. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. Sharp knives were locked in a drawer in the kitchen. Chemicals and cleaning supplies were locked in a cabinet inside the laundry room and in a cabinet below the kitchen sink. Medications will be locked in a container inside a cabinet in the kitchen area. The hot water was at a temperature of 114.8 degrees Fahrenheit. The First Aid Kit was accessible and placed in a kitchen drawer. There was one fire extinguisher present in the home located in the kitchen area. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. The home has a pool that is appropriately fenced. The pool fence was measured at five feet and three inches that surrounds the pool completely. The gate is self-latching and opens outwards. The backyard is fully fenced and free of debris. There are no cameras in the home. There are no corrections to be made. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Grace Damisah via email. Application will be forwarded to Licensing Program Manager Abdoulaye Traore for licensure.

met_with: Applicant-Grace Damisah


facility_name: HOWARD SMALL FAMILY

summary: Facility Evaluation

raw_content:
Narrative:
On June 26, 2024 at 10:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Howard Small Family Home. LPA met with Applicant Danielle Howard and staff Enoch Martinez who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are two clients in placement. The home is a two story building with three bedrooms and two and one half bathrooms which are set up as follows: · Bedroom #1 (Applicant) It consisted of a king bed that sleeps applicant and adult. · Bedroom #2- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · A living room, kitchen, dining area, laundry room, two car garage and a backyard. The garage will be utilized as storage and office space. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked, and they were working properly. The Carbon Monoxide detector is located downstairs in the hallway and was checked and working properly. The home's central air conditioning module was located in the backyard. The water heater was located in the garage. The appliances were in working order. The client's files will be locked inside a filing cabinet in the garage. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives and medications are in a locked cabinet in the dining area. The hot water was at a temperature of 115.2 degrees Fahrenheit. The First Aid kit was accessible and is located in the pantry with all required supplies. There was one fire extinguisher present in the home located in the dining room. It was observed to be properly charged and inspected by the fire department. There are no fire arms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. No corrections to be made. An exit interview was conducted and a copy of this report was provided to applicant Danielle Howard. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensing.

met_with: Licensee-Danielle Howard


summary: Facility Evaluation

raw_content:
Narrative:
On July 8, 2025, at 10:35AM, Licensing Program Analyst (LPA) Raina Perez-Diaz completed a Post-licensing/annual inspection of Howard Small Family Home. LPA met with Licensee Danielle Howard and staff Enoch Martinez who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there are two clients in placement. The home is a two story building with three bedrooms and two and one half bathrooms which are set up as follows: · Bedroom #1 (Licensee) It consisted of a king bed that sleeps Licensee and adult. · Bedroom #2- It consisted of a single bed. The bed had linen, comforters, and pillows. Where Child #1 (C1) sleeps. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. Where Child #2 sleeps. · A living room, kitchen, dining area, laundry room, two car garage and a backyard. The garage is utilized as storage and office space. The clients' bedrooms were arranged so that no more than one client will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked, and they were working properly. The Carbon Monoxide detector is located downstairs in the hallway and was checked and working properly. The home's central air conditioning module was located in the backyard. **Continued on LIC 809-C*** The water heater was located in the garage. The appliances were in working order. The client and staff files were locked inside a filing cabinet in the garage. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives and medications are in a locked cabinet in the dining area. The hot water was at a temperature of 115.7 degrees Fahrenheit, which is within regulation. The First Aid kit was accessible and is located in the pantry with all required supplies. There was one fire extinguisher present in the home located in the dining room. It was observed to be properly charged and inspected by the fire department. There are no fire arms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. LPA Perez-Diaz reviewed files for two clients in care [Client #1 (C1) and Client #2 (C2)]. All clients' files were found to have Cash/Property/Valuables records, Medical Consent forms and signed needs and services plans. LPA also reviewed four staff files for [Staff #1 - Staff #4 (S1-S4)]. All staff files reviewed have Department of Justice (DOJ), Federal bureau of Investigation (FBI) and Child Abuse Clearance Index (CACI) clearance, proof on file of acknowledging the child abuse reporting requirements and meet the minimum qualifications and training requirements per Community Care Licensing Regulations. A review of administrative records indicate that the facility has paid their current licensing fees. Additionally, two staff interview and one client interview were conducted. One client is non-Verbal as confirmed by Licensee and the clients Needs and Services Plan. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report and the LIC 811, were provided to Danielle Howard.

met_with: Licensee- Danielle Howard


facility_name: HOWARD SMALL FAMILY HOME

raw_content:
Narrative:
Additionally, it was stated that staff record or take pictures of children prior to leaving the home to document their clothing, behaviors, and mood for the day. Administrator provided LPA with video and pictures of children documented from day injury was observed. LPA observed slight discoloration in the picture above child's eye in the crease of child's eyelid. However, child appeared happy, smiling in photo and it was unclear as to whether the discoloration was a bruise. Staff had similar statements to Administrator in that the mark was not noticed prior to child leaving for school. Staff stated that child did not exhibit any discomfort or identify being in any sort of pain. Interviews conducted with one client did not express any concerns with the home or observing anyone being hit or obtaining a bruise. Two clients were non- verbal, however LPA observed children in the home and at school and children did not appear to be uncomfortable with staff or assigned teachers. Children were observed to be happy, clean and in good health. LPA was unable to ascertain answers to questions LPA posed to children due to limited verbalization as to whether children ever received an injury or bruise while residing in the home. Interviews conducted with school administration identified noticing the discoloration in the crease of child's eyelid. However, school staff were unable to identify where or how the mark was obtained. LPA reviewed supportive documents provided by facility and no incidents were documented where a client was taken to the hospital for injuries or where observations were made of child having an injury. LPA was unable to contact county social worker, but no documents identified a problem with clients placed in the home or facility staff. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 05/10/ Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the Howard Small Family Home to deliver the findings to the above identified complaint investigation. LPA spoke with Administrator Danielle Howard and informed Administrator of investigative findings. Investigation consisted of the following: On 3/25/ LPA conducted 10-day inspection to facility and interviewed one (1) child, Administrator and one (1) staff (see LIC 811 confidential names, dated March 25, 2022). On 3/30/ LPA interviewed/ observed two (2) children. Additionally, LPA attempted to contact social workers and additional staff. On 4/07/ LPA reviewed documents received. Investigation revealed the following: It was alleged that minor sustained an unexplained injury while in care. Administrator denied the allegation. Administrator stated that bruising was not noticed on child prior to child being dropped off to school. Administrator stated that prior to children being picked up for school, children are looked over by Administrator and staff as well as bus driver. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HOWARD SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/10/2022

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

met_with: Danielle Howard, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Janeth Chavez met with licensee, Ms. Danielle Howard. Licensee provided LPA with a tour of the home. The purpose of the visit was to conduct an Annual Required inspection of the Howard Small Family Home. The facility was toured inside and out with Ms. Howard. Currently there are Regional Center clients in the facility and the licensee has guardianship. There were no clients present during the inspection. There are only two adults living in the home and they have fingerprint clearance. At 12:20PM, LPA conducted a walk-through of the home. This is a two-story home and consists of 4 bedrooms 2 ½ bathrooms. The bedroom downstairs is located near the entrance and is for Client #1. Bedroom 2-4 are located upstairs. Bedroom #2 has two beds and is for Client #2. Bedroom #3 has bunk beds and is for Client #3. Bedroom #4 is licensee's Master Bedroom with full bath and is only for licensee and spouse. There is only one child per bedroom. No rooms are commonly used for other purposes and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for the children's belongings. There is a fireplace in the family living room area and is properly screened. The licensee keeps knives and hazardous items inaccessible to children. Licensee keeps all detergents and knives locked and stored near the laundry room. Licensee stated there are no medications in the home except over the counter medications. As per licensee, there are no guns or weapons in the home. LPA observed proper storage of food in the refrigerator and the pantry area. LPA observed trash cans with proper tight-fitting lids. LPA tested the hot water temperature to be within regulatory requirements. The combo smoke detector and carbon monoxide located upstairs, and downstairs were tested and were in operable condition. LPA observed the Emergency Disaster Plan, Exit Map, Personal Rights and License posted on the wall near the kitchen area. LPA observed the backyard free of hazards. LPA did not observe any bodies of water, pools or jacuzzi in the home. LPA observed age appropriate toys for the children in the home. At 1:05PM LPA conducted records review for staff and children. A review of staff records on this date indicates that all facility staff have received criminal record and child abuse index check clearances. Licensee and spouse have proof of CPR/First Aid cards for 2021. No deficiencies were cited on today's date. Exit interview conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to facility licensee, Ms. Howard, appeal rights given and explained.

met_with: Danielle Howard


facility_name: HUDSON HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On September 09, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Hudson Home and met with Dolores Huddleston. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA toured the facility, reviewed documents, interviewed staff, and clients. Valley Mountain Regional Center (VMRC) stated that S1 choose not to pick up C1 because "S1 felt it would be difficult to control or monitor C1's foods." VMRC stated that they offered S1 resources so that S1 could continue to keep C1 in her placement; however, she refused the services. LPA Barragan reviewed the documentation provided by VMRC and it confirmed these information/findings as well. "Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.") Due to the deficiency's listed above one deficiency is being cited on today's visit. An exit interview was conducted, and a copy of the report and appeal rights were provided to Dolores Huddleston. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/10/2021 and conducted by Evaluator Eduardo Barragan PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:HUDSON HOMEFACILITY NUMBER: ADMINISTRATOR:HUDDLESTON, DOLORESFACILITY TYPE: ADDRESS: DYER LANETELEPHONE: (209) 408- CITY:MODESTOSTATE: CAZIP CODE: CAPACITY:6CENSUS: 5DATE: 09/08/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Daloris HuddlsonTIME COMPLETED:10: AM 9Facility has inappropriate interaction with resident. INVESTIGATION FINDINGS: 13On September 9, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Hudson Home and met with Dolores Huddleston. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging " Facility has inappropriate interaction with resident." LPA Barragan spoke with staff, clients and reviewed other predominant documents. Based on documents reviewed, an inspection, and conversations all the information that was gathered was conflicting. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED." An exit interview was conducted with Dolores Huddleston. A copy of this report and appeal rights were provided to Dolores Huddleston. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: 507004129

met_with: Dolores Huddleston


raw_content:
Narrative:
Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel BruAcce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On March 8, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint outlines the following substantiated allegations: Facility is using inappropriate discipline specifically that C1 would recieve a shower for disciplinary purposes. Out of 15 interviews completed 10 interviews were consitent in confirming that to be the case. While it could be said the action was taken to redirect behavior, per regulations this is considered a form of punishment. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

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

met_with: Delores Huddleston


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
1. Staff did not ensure that client received an appropriate haircut. Photos of C1 were obtained before and after the haircut which reveal that the hair cut was too short for the type of hair C1 has. Additionally, licensee did not obtain prior authorization to cut C1's hair from biological parent or county social worker. 2. Facility is not meeting resident's hair care needs. Interviews confirm the haircut was done because C1's hair needs were not being met. Interviews and record review reveal licensee did not provide the proper haircare products that were appropriate for C1's hair type. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On February 4, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint outlines the following substantiated allegations: SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

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

met_with: Delores Huddleston, Licensee

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on the information obtained, and by the licensee's own admission, there is a preponderance of the evidence to prove the above allegation is substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On January 12, 2022 the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint alleged that the facility is operating out of staff ratio. Based on agreed services to be provided to clients the facility does not have enough personnel on duty to meet their obligation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022


raw_content:
Narrative:
1. Staff used inappropriate forms of punishment: Interviews revealed that staff would give C1 a long shower as a disciplinary measure and when PC1 was given a shower to help him sleep, he would be left to stand and air dry for a long period of time after the shower was completed. These personal right violations pose an immediate risk to the health and safety of the client's involved. 2. Medication not dispensed as prescribed: Record review and interviews provid evidence that PRN medication dispensed to clients is not in accordance with the prescription or in alignment with regulations. Staff provided Benadryl and Melatonin to all the residents on a regular and consistent basis beyond the PRN guidelines. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On January 11, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint outlines the following substantiated allegations: SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

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


raw_content:
Narrative:
Parties interviewed provided conflicting information regarding this issue. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations that staff would hit and instigate the clients to hit each other are deemed to be UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to Dolores Huddleston along with appeal rights.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On January 5, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint alleged that staff would hit the clients and instruct them to hit each other. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

met_with: Dolores Huddleston, Licensee


summary: Complaint Investigation - Unsubstantiated - 1 deficiency

raw_content:
Narrative:
The complaint outlines the following substantiated allegations: 1. Staff handled client in a rough manner- Several interviews had consistent facts that a staff (S2) handled C3 was handled in a rough manner when he was taken down. 2. Staff used inappropriate forms of punishment- LPAs conducted 15 interviews, and 9 were consistent in fact that C1 is given showers as a form of re-direct during a behavior episode. This is considered by the Department as an inappropriate form of punishment. 3. Staff did not meet the grooming needs of client's in care- According to C1's IPP from October 2021, the placement agency approved funding for a chewing necklace to help prevent C1 from chewing her hair as it was a constant problem. However, several interviews confirm that the facility staff did not know how to comb C1's hair due to the lack of proper hair products and cultural competency. Receipts were produced by licensee however the products purchased did not reflect the appropriate products that were needed to meet C1's grooming needs. 4. Staff did not receive appropriate training- Interviews and records revealed that staff did not receive formal training on client care, medication handling and de-escalation techniques. The training records produced by the licensee are not clear as to when the staff received training. Staff certificates for medication management show a much later date from the date of hire for most of the employees. Records demonstrate that staff were giving medication to residents without formal training. Additionally, records do not indicate staff received proper training in de-escalations techniques which is confirmed by the interviews conducted. 5. Staff did not follow weekly menu as posted- As part of initial training, staff are required to be trained in menu preparing. Based on interviews, the facility staff do not prepare or follow the menu posted. When changes are made to the menu, there is no record of what was substituted as required by the placement agency. There were no records of what was served at any meal. 6. Licensee interferes with resident's activities- There are no current records that show the activities provided by the Licensee as required by the regulations. Interviews state the token reward system is used to address good behavior however, token reward system is ineffective and limits and/or restricts the activities. By limiting and restricting activities licensee is interfering with the resident's activities. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPAs) Cynthia Galindo and Rachel Bruce, who were accompanied by Community Service Liaison (CSL) Rukaiyah Jones from Valley Mountain Regional Center (VMRC), conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. On January 12, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

Deficiencies:
80065: (f) All personnel shall be given on-the-job training shall have related experience which provides knowledge of and skill in the following areas (1) Principles of nutrition, food preparation and storage and menu

title: (f)(1) Personnel Requirements


raw_content:
Narrative:
The complaint outlines the following substantiated allegations: 1. Child does not have adequate clothing- According to interviews and record review, clients wear clothes that are too big or too small and are not always seasonally appropriate. 2. Staff are not following protocols to prevent the spread of illness. The licensee submitted an incident report to the Department stating PC1 tested positive for COVID on 01/25/2022. School records shows PC1 attended school for four days after receiving the positive results and being instructed by the County Health Department to quarantine for 10 days. 3. Child's medications are mismanaged- Interviews and record review reveal that PC1 had a change in medication which was not communicated to school staff and not provided to school to provide appropriately. 4. Children are not adequately supervised by staff- Interview and records reveal the home is out of staff ratio according to the needs of the children in care and in turn cannot provide adequate supervision. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPAs) Cynthia Galindo and Rachel Bruce, who were accompanied by Community Service Liaison (CSL) Rukaiyah Jones from Valley Mountain Regional Center (VMRC), conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. On February 3, 2022 the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022


raw_content:
Investigation Findings:
13On May 26, 2023, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. On March 1, 2023 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), confidential interviews, along with a comprehensive review of staff, client, and administrative records. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: 507004129

met_with: Caitlyn Holcomb, House Manager


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA), Lidia Tinoco conducted an unannounced visit to the Hudson Home in order to deliver the findings of the above allegations and met with Paul Koughn in the absence of Caitlyn Holcomb, House Manager and Delores Huddelston, Administrator. On October 30, 2023, the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, interviews and a review of records. The complaint alleged that the Licensee did not ensure that staff receive training. The people interviewed and the documentation reviewed provided conflicting information regarding this issue. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. A copy of this report was discussed and provided along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco 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 2

met_with: Paul Koughn


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst, Brinae Pointer traveled to Hudson Home and met with House Manager, Caitlyn Holcomb to deliver findings of investigation. LPA Pointer conducted investigation that included review of documentation and confidential interviews. Based on inconsistencies in the information obtained, a preponderance of the evidence could not be obtained. Although the allegations may or may not have occurred or may or may not be valid, without a preponderance of the evidence the allegations are deemed Unsubstantiated. An exit interview was conducted, and a Copy of this report was left at facility at the conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Brinae Pointer 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


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Investigation Findings:
13On December 1, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Hudson Home and met with Nancy Celaya. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging "Adults speak inappropriately towards a minor while in care." LPA Barragan spoke with staff, clients and reviewed other predominant documents. Based on documents reviewed, an inspection, and conversations with staff and clients, all the information that was gathered was conflicting. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED." An exit interview was conducted with Nancy Celaya. A copy of this report and appeal rights were provided to Nancy Celaya. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan 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 2

met_with: Nancy Celaya


raw_content:
Investigation Findings:
13On December 1, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Hudson Home and met with Nancy Celaya. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging "Staff yell at the minors." LPA Barragan spoke with staff, clients and reviewed other predominant documents. Based on documents reviewed, an inspection, and conversations with staff and clients, all the information that was gathered was conflicting. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED." An exit interview was conducted with Nancy Celaya. A copy of the report and appeal rights were provided to Nancy Celaya. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan 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 2


summary: Facility Evaluation

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Narrative:
On May 23, 2022, Regional Manager, Nelson Martinez; Licensing Program Manager, Juanita Arroyo; and Licensing Program Analysts, Cynthia Galindo and Rachel Bruce, conducted a non-compliance conference with Administrator, Dolores Huddleston. Attending the meeting via teleconference were representatives from Valley Mountain Regional Center, Rukaiyah Jones and Katina Richison; Stanislaus County social workers, Isabel Ramirez-Jimenez, and Shakena Graves; San Joaquin county social worker Pedro Rodriguez; and Sacramento South Adult and Senior Care LPM Stephanie Doub and LPA Stacy Barlow. The conference is documented on LIC 91111 dated 05/23/2022

met_with: Dolores Huddleston, Administrator


summary: Facility Evaluation

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Narrative:
On this date, Licensing Program Analysts (LPAs) Rachel Bruce and Briana Placencia conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Random inspection. LPAs met with Dolores Huddleston, Administrator. A tour of the facility was conducted. Time restraints prohibited completion of the inspection on this day. A copy of this report was provided to the Administrator. LPA Bruce will return at a subsequent time to conduct review of the staff and client files.


summary: Facility Evaluation

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Narrative:
On July 1, 2022, Licensing Program Analyst (LPA) Rachel Bruce returned to Hudson Home to continue and finalize annual inspection which began on June 27, 2022. On this day, record review of staff and client files was conducted. LPA Bruce met with Dolores Huddleston and reviewed outcome of annual inspection, two deficiencies related to Physical Plant regulations were administered and Plans of Correction were cleared as issues have been remedied. Window screen and door have been replaced in resident bedroom.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analysts (LPA) Rachel Bruce conducted a Case Management inspection at Hudson Home and met with House Manager, Kate Holcolmb. The House Administrator, Dolores Huddleston was not present due to handling a medical appointment and transport of a family member. The visit today is part of the Non-compliance meeting agreement that took place on May 5, 2022. LPA conducted an inspection of the facility, reviewed medical dispensing records and procedures, as well as client activity calendars, staff training files and staff scheduling. There were two clients present on break for Christmas Holiday. There are a total of two clients residing in the facility. No regulation violations noted at today's visit. No deficiency issued. A copy of this report was left at the facility.

met_with: Kate Holcolmb, House Manager


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Rachel Bruce conducted a Case Management inspection at Hudson Home and met with House Manager, Caitlyn Holcolmb. The visit today is part of the Non-compliance meeting agreement that took place on May 5, 2022. LPA conducted the following as part of the inspection: Physical inspection of the facility. No regulation violations were noted. Bedrooms, bathrooms, common areas and kitchen were clean and in good repair. LPA reviewed the following documentation for compliance: medication dispensing logs, and staff schedules. Staff files, Client files, activity calendar, training records were reviewed in May, 2023. Inspection revealed no Regulation violations and above records are in compliance. Food Service was within regulations. There was adequate fresh fruit and non-perishable items Since last inspection one client has left the facility so current census is three with a capacity of six. Present in the home at today's visit was House Manager, two direct staff, and two clients. Dolores Huddleston was attending a medical appointment and the outstanding client is with another staff member at a dental appointment. No regulation issues noted and no citations delivered at today's visit.


summary: Facility Evaluation

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Narrative:
On June 26, 2023, Licensing Program Analyst (LPA) conducted an unannounced annual required inspection at the facility. LPA Bruce met with Caitlyn Holcomb, Administrator. Utilizing Care Tools, LPA Bruce conducted a review/inspection of the physical plant, reviewed operations, emergency plan, medicine distribution/storage, living quarters, stored chemicals, fire extinguishers, smoke detectors and a thorough inspection both inside and outside. There were no deficiencies noted as the facility was in compliance with the above categories. Per the Administrator, there are no weapons, pets or bodies of water at the facility. A review of the clients records was conducted and no deficiencies were noted, however a technical advisory was issued for an updated admission agreement for two clients. LPA Bruce will conduct a review of staff records and finalize the required annual inspection at a later date.

met_with: Caitlyn Holcomb, Administrator


summary: Facility Evaluation

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Narrative:
On July 7, 2023, Licensing Program Analyst (LPA) Rachel Bruce, arrived for an unannounced visit at the facility for the purpose of discussing clearance requirements for associated personnel and medical care personnel who are not considered employees of the facility. A review of documentation was conducted. Currently the agency has retained the services of Behaviorist who currently holds certification from the Behavior Analyst Certification Board effective through 11/30/23. The following regulation applies: 80019 (b): Criminal Record Clearance: The following persons are exempt from the requirement to submit fingerprints: (1) A medical professional, as defined by the Department in regulations, who holds a valid license or certification from the individual's governing California medical care regulatory entity and who is not employed, retained, or contracted by the licensee, if all of the following apply: (A) The criminal record of the individual has been cleared as a condition of licensure or certification by the individual's California medical care regulatory entity. (B) The individual is providing time-limited specialized clinical care or services. (C) The individual is providing care or services within the individual's scope of practice. (D) The individual is not a community care facility licensee or an employee of the facility. The Behaviorist has provided documentation from DOJ which reflects she has obtained clearance from them. This behaviorist will be asked to provide proof that she holds clearance relating to her certification. Until this issue is cleared the behaviorist will not be allowed in the facility.


summary: Facility Evaluation

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Narrative:
On November 6, 2023, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced inspection for the purpose of reviewing staff / client files. While reviewing the file of a new placement (see confidential Names List attached) it was noted that there was a report in their file that had not been submitted to Community Care Licensing as an incident report. The report was regarding an incident that had occurred while the client was being transported from school. During transport another student had assaulted him causing only a minor injury but police were called and pictures were taken for the police report. Discussion was had with Ms. Holcomb as a reminder of when an incident rises to the level of an incident report and when CCL should be notified. IN the above case, there was an injury and police involvement and although the client in question was not the aggressor it qualifies as an unusual incident and should have been reported. Ms. Holcomb will submit an incident report within 24 hours and supplied LPA Bruce with the report from the school and pictures. No citations issued during today's visit.


summary: Facility Evaluation

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Narrative:
On February 16, 2024, Licensing Program Analyst (LPA) Lidia Tinoco conducted a Case Management inspection at Hudson Home and met with House Manager, Caitlyn Holcolmb. The visit today is part of the Non-compliance meeting agreement that took place on May 5, 2022. LPA conducted the following as part of the inspection: Physical inspection of the facility. No regulation violations were noted. Bedrooms, bathrooms, common areas and kitchen were clean and in good repair. LPA reviewed the following documentation for compliance: medication dispensing logs, staff schedules. staff files, Client files, activity calendar, and training records were reviewed. The Inspection revealed no Regulation violations and the above records are in compliance. Food Service was within regulations. There was adequate fresh fruit and non-perishable items. Present in the home at today's visit was House Manager, one direct care staff, and one client. Dolores Huddleston was not present at the time of inspection. The current Client Census is 5. No deficiencies were observed or cited on todays visit.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs), Lidia Tinoco, Brinae Pointer and Sonia Sanchez arrived at Hudson Home for the purpose of conducting an unannounced Annual/Random inspection. LPAs met with House Manager, Caitlyn Holcomb and Administrator Dolores Huddleston and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. Facility smoke detectors were tested and appear to be in appropriate working order, fire extinguishers were observed. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one week supply of nonperishable and a two day supply of perishable foods. The facility is maintained at 72 degrees. Administrator, Dolores Huddleston is present at the facility. Appropriate staff/client ratios were observed during this inspection. The facility employs 1 facility manager and 9 direct care staff. 5 records of personnel/staff members were reviewed to ensure staff meet regulatory requirements. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site. 5 records of clients were reviewed. Staff interviews and Client interviews were conducted, other child interviews were not conducted due to the children being non-verbal. There was one Technical Assistance issued on today's date. The Licensee is meeting the conditions of their license. The non-compliance initiated on May 5, 2022 has concluded. A copy of this report was provided at the conclusion of the inspection along with appeal rights.

met_with: Caitlyn Holcomb


summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analysts (LPA) Brinae Pointer arrived at Hudson Home for the purpose of conducting an unannounced Annual/Random inspection. LPA met with House Manager, Caitlyn Holcomb and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. Facility smoke detectors were tested and appear to be in appropriate working order, fire extinguishers were observed. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one week supply of nonperishable and a two day supply of perishable foods. The facility is maintained at 73 degrees. The facility employs 1 facility manager and 11 direct care staff. 5 records of personnel/staff members were reviewed to ensure staff meet regulatory requirements. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site. 5 records of clients were reviewed. This LPA will return to the facility to interview both staff and residents on site. No interviews were conducted on this date. A copy of this report was provided at the conclusion of the inspection along with appeal rights.

met_with: Caitlyn Holcomb, Facility Manager


summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analysts (LPA) Brinae Pointer arrived at Hudson Home for the purpose of completing interviews pertaining to the unannounced Annual/Random inspection. LPA met with Facility Manager (FM), Caitlyn Holcomb and observed there was a youth present in the home. LPA Pointer was provided documentation in the form of an updated Needs and Services Plan, and updated shot records. LPA was informed by FM of staff coming into the home as scheduled at around 1:30PM, and 2: PM. LPA advised the interviews would be conducted as the staff arrived. During this inspection, LPA Pointer interviewed two youth in care, and three staff. Of the five youth in care, 3 are verbal, and 2 are non-verbal as observed by LPA Pointer from within the facility, and reviewing client files. While completing the inspection, FM asked LPA about visitations of client family members that are on probation. LPA informed staff, any visitors that are not able to clear a background check or fingerprint clearance are not permitted near these children as a protected class. There were no deficiencies cited upon completion of this annual inspection.


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brinae Pointer, conducted a complaint inspection and met with Caitlyn Holcomb. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on interviews it was determined that Staff did not ensure youth was provided privacy while showering. Based on the LPA's confidential interviews and records review which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A deficiency is being cited for the Interim Licensing Standards (ILS) Chapter 8.8, Articles 9, Section 88487.8(b)(2) Personal Rights. A copy of the report and Appeal Rights was provided to the FFA. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Brinae Pointer 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: 507004129

met_with: Caitlyn Holcomb,House Manager/Administrative Designee


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On June 28, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted an unannounced annual required inspection at the facility. LPA Barragan met with Dolores Huddleston, Administrator. An inspection of the facility was conducted and the following was observed: Client and staff files were inspected on this date. The facility was inspected indoors and outdoors. Hot water temperature measured at 106 degrees. LPA observed the supply of perishables and non-perishables. However, LPA Barragan noted that multiple of the perishables and non-perishables were expired. LPA observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals inaccessible to clients. Medications centrally stored and locked. There are no pets at the facility. Per the Administrator, there are no weapons at the facility. There are no bodies of water at the facility. There have been no deficiencies in the prior 12 months. A review of staff records on 6/28/2021, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Two deficiency were noted on the attached page. LPA Barragan left a copy of this report at the facility. The visit was then concluded.

Deficiencies:
80066: (6) Documentation of the educational background, training and/or experience specified in licensing regulations...
80076: (1) All food shall be safe and of the quality... All food shall be...stored, prepared and served in a safe and healthful manner.

title: Personnel Records (a) The licensee shall ensure that...Each personnel record shall contain the following information

title: Food Services (a) In facilities providing meals to clients, the following shall apply


summary: Facility Evaluation

raw_content:
Narrative:
On October 1, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted an unannounced case management inspection at the Hudson Home. LPA Barragan met with Dolores Huddleston, Licensee. While conducting the house inspection LPA Barragan noted that one of the clients mattress was on top of wooden pallets. The pallets were disarranged, uneven and not in compliance with regulations. The Licensee stated that the she thought the wooden pallets would substitute as bed frame; however, after reviewing regulations the Licensee stated that she will provide the minor a bed frame within week. LPA Barragan review bed regulations with the Licensee as well. One citation is being issued on todays visit. A copy of this report and appeal rights was provided to Dolores Huddleston, Licensee.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced Case Management visit to Hudson Home in order to deliver deficiencies regarding several areas of concern. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. Dolores Huddleston was informed that as a result of recent interviews and a comprehensive review of documentation included in both client and staff files, the following non-compliance deficiencies came to light and the following citations are being issued. 1. A non-staff occupant (NSO) of the home would speak inappropriately to and in front of clients. Interviews with staff revealed that NSO would use the terms "nigger", "bitch", and "witch" when referring to a client in care. Water temperature. The temperature of the water was tested and took an unacceptable amount of time (8 minutes) to come to reach level of heat required. 3. Staff schedule- Staff files did not denote hours worked and schedule provided lacked clear denotation of who was working and when. 4. Staff are not trained on cultural competency- 5. Licensee not on premises despite requirement to be present. Deficiencies cited today and a copy provided to Licensee.

Deficiencies:
80066(f): (f)	In all cases, personnel records shall document the hours actually worked.

title:
1
2
3
4
5
6
7Personnel Records


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analysts (LPA) Rachel Bruce and Lidia Tinoco conducted a Case Management inspection at Hudson Home and met with House Manager, Kate Holcolmb. The visit today is part of the Non-compliance meeting agreement that took place on May 5, 2022. LPAs conducted the following as part of the inspection: Physical inspection of the facility. No regulation violations were noted. Bedrooms, bathrooms, common areas and kitchen were clean and in good repair. LPAs reviewed the following documentation for compliance: Staff files, Client files, medication dispensing logs, staff schedules, activity calendar, training records. No regulation violations were noted. Food Service was within regulations. There was adequate fresh fruit and non-perishible items Water temperature in client bathroom has an ongoing issue of the water temperature taking a long time to heat up. Citation being issued to address that at today's visit. There was one client present and three clients attending school. A copy of this report, the citation and appeal rights were provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced case management inspection with Hudson Home to discuss serious regulation violations. As a result of recent confidential interviews and a comprehensive review of documentation included in both client and staff files, the following violations were substantiated and deficiencies will be cited at today's visit. 1. Staff took a client to Administrator's mom's house to provide care for her. By the Administrators own admission, a previous staff member went to her mother's home to provide care to the elderly mother. This employee took a client from Hudson Home with her that she was assigned to supervise one on one. The Administrator was aware that this happened on two separate occasions. 2. Current Staff member not associated to the - Records pulled from the Licensing Information System reflect that a current employee is not associated to the facility. (Civil Penalty) See confidential names list LIC811 attached 3. Personnel records do not reflect accurate data. Staff schedules for the period of September 26, 2022 through March 19, 2023 reflect that a current employee is on the schedule during that time however that employee by her own admission stated she has not worked in the facility since the summer of 2022. Based on the above, there is a preponderance of evidence to substantiate violations of the California Code of Regulations which are being cited on the attached LIC 809D.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 28, 2023, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced case management inspection. The purpose of the visit is to address non-compliance regarding the facility's inability to maintain the correct staff ratio. On June 26, 2023, LPA Bruce conducted an unannounced visit to the facility for the purpose of conducting the annual required audit. Upon arriving at the facility, LPA noted that there were three clients and two staff present. Two clients require one-on-one staff supervision so if all three clients are present, three staff are required to be present. Because there was not sufficient staff present to meet the needs of the clients in care, a deficiency is being issued today. Previously on May 26, 2023, a citation for the same offense was issued. Because this is a repeat offense within a 12 month period, a civil penalty is being assessed. An exit interview was held with Dolores Huddleston, a copy of the report, deficiency, civil penalty and appeal rights were provided.

Deficiencies:
80065(a): Facility personnel shall be competent to provide the services...to meet the client needs and shall, at all times, be employed in numbers necessary to meet such needs.

title:
1
2
3
4
5
6
7Staff Ratio


facility_name: HUGHES SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas made an announced visit to the Hughes Small Family Home to conduct an Annual/Required inspection on 07/20/2021 at 10:30am for the purpose of conducting an Annual/Required Inspection. LPA Rosas met with Licensee who granted access to the home and an inspection of the home was conducted together with the Licensee (A1). The facility is a two-story family home in a gated residential neighborhood and it has four (4) bedrooms, three (3) bathrooms, living room, kitchen, dining area, backyard, fireplace with a secured screen on attached two car garage. The home is licensed to serve (4) four developmentally disabled children, ages 5-17 years, ambulatory only. The annual fee is current. Currently in placement are zero (0). Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 07/20/21. LPA observed the follow during the inspection: Bedroom #1(upstairs): Is occupied by A1. There is one king size bed, adequate drawer space, closet and lighting. There is a private large bathroom and a walk-in closet in this room. Bedroom #2 (upstairs): Is vacant. There are two twin size beds, adequate drawer space, closet and lighting. Bedroom #3 (upstairs): Is vacant. There are two twin size beds, adequate drawer space, closet and lighting. Bedroom #4 (upstairs): Is vacant and used as a guest bedroom. The room has one twin size bed, adequate drawer space, closet and lighting. Loft (upstairs): Is used as a internment room. There is an emergency ladder available Laundry room (upstairs): ): There is a washer and dryer. Cleaning supplies and detergent are stored above the washer this room is kept locked. Medications, disinfectants, and cleaning solutions are inaccessible to children. The home has multiple functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. Report continues LIC809C LPA Rosas observed a fire extinguisher in the kitchen and in multiple places around the home that was operable at the time of inspection. Perishable and non-perishable food is adequate in the home. There are no bars on the windows. The home is operating within the capacity and limitations of the license. Children have individual beds, comfortable mattresses, clean lines, blankets, and pillows that are in good repair. There is adequate hygiene and grooming supplies. No room commonly used for other purposes is used as a bedroom. The home is clean, safe, sanitary, and in good repair. Facility has non-perishable foods for one week and perishable foods for two days. Facility provides nutritious snacks between meals. Medications are locked and accessible only to employees responsible for stored medications. Facility posts child's rights in dining area adjacent to kitchen. Clients are not restricted in telephone use except by court order. LPA Rosas will return and continue with the annual inspection to be able to review reviewed staff records. Facility operates within license capacity and limitations. All posting requirements were met. An advisory note was given for 83187(g), 80087(a), 83187(f). A1 stated, she will remove papers and clean up office, living space, and kitchen. A review of Facility's Personnel Report Summary on 07/19/2021, indicates that all adults residing and working in the home have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There are no deficiencies noted or cited. Exit Interview was conducted, and a copy of this report was email to the licensee.

met_with: Licensee