summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Continuation Inspection. The 3 currently occupied homes were toured with the assistance of Rene Sorrosa. Water temperatures measured were 105.1, 115 and 119.8 respectively. LPA Hiett interviewed 5 clients at the school, medication records for 10 clients were review. The Annual/Required inspection is complete. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted with Chief Residential Program Office Scott Singer and a copy of the report was left at the facility.


state: CA

facility_name: HANNA BOYS CENTER, GROUP HOME, BLDGS 400 & 405

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection for the purposes of completing an Required 2 year Inspection and met with administrator Scott Singer. The Physical Plant was toured inside and out. Water temperatures were measured at 114F. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPA inspected bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxins and cleaning solutions are in a locked cabinet. Required documents are posted. There are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. Client and staff files were reviewed at the administration office and are complete and current with required documents. Per Title Regulations, no deficiencies were cited during this inspection.

report_type: Facility Evaluation

met_with: Scott Singer


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and Nicole del Calvo conducted an unannounced inspection for the purposes of completing an Annual/Random Inspection and met with Manager of Residence Jeremiah Presinal. The Physical Plant was toured inside and out by LPAs. Water temperatures were measured at 120F. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPAs inspected bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxics and cleaning solutions are in a locked cabinet. Required documents are posted. There are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. 4 clients were interviewed. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of this report was left with the facility.

visit_type: Annual

met_with: Jeremiah Presinal


summary: Facility Evaluation

raw_content:
Narrative:
On the above date Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of continuing an Annual/Random Inspection and met with Manager of Residence Jeremiah Presinal. 5 staff files and 5 client files were reviewed at the administration office. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left with the facility.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 5/13/25, Licensing Program Analyst (LPA) Mariah Hawkins visited the facility in order to conduct a youth interview regarding an outside matter. LPA met with Director Jeremiah Presinal and informed of the visit. The visit was scheduled in advance, and Director facilitated the interview by securing a meeting location and notifying the youth of LPA's visit. LPA conducted one confidential youth interview. An exit interview was conducted, and a copy of this report was provided to Director Jeremiah Presinal.

met_with: Director Jeremiah Presinal


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and Kimberly Hall made an unannounced visit to the facility and met with Senior Director of Residence Jeremiah Presinal. The purpose of the visit was to follow up on incident reports with the facility. LPAs toured the facility and examined records and reviewed the incident reports with Mr Presinal. The first set of incident reports were dated September 17, 18, and 19, 2025, and were to report occurrences of medication not being available for the client. It was also discussed that similar occurrences had been reported for other clients. Mr Presinal indicated that they had issues with a Psychiatrist leaving and changes with a pharmacy. The second report reviewed was dated 9/17/25 and was involving a client ingesting a laundry pod. Mr Presinal stated that their pods are non-toxic and they review procedures with the clients to ensure safety. An exit interview was conducted with Jeremiah Presinal and no deficiencies were cited.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced visit to the facility and met with Jeremiah Presinal. The purpose of the visit was to conduct a Case Management Inspection regarding two Incident Reports. The first incident occurred on 01/22/2026 and was a report of a staff person and youth having personal contact outside of the facility operations. LPA requested an update on the facility's investigation and they are sending a copy. Facility has terminated staff for inappropriate communication, but no other inappropriate activity was found. The second incident was from 11/29/25 and was a report of an 18-year old youth in the facility expressing a desire to have sex with a 16 year old male from the school. LPA determined that the Group Home Program Statement does not address care and support of 18-21 year old clients. LPA is issuing and Advisory Note on updating the Program Statement per Title Section 84022(b)(1)and(2).. No citations were issued at this visit. An exit interview was conducted with Jeremiah Presinal and Penn Chourre and a copy of this report was given to the facility.

met_with: Jeremiah Presinal and Penn Chourre


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPA) Brian Bertoli made an unannounced visit to the facility and met with Senior Director of Residence Jeremiah Presinal. The purpose of the visit was to follow up on incident reports with the facility. The first two incident reports were dated 01/28/26, and were to report two occurrences of restraints for the same youth and there were no indications of notification to the Authorized Representative and one report was missing the restraint type and duration. Facility is resubmitting reports with missing information and confirmed that Authorized Representatives were notified.. The third incident was for the same youth on 01/17/2026 and was for medication not being available for the client. It was also discussed that similar occurrences had been reported. Mr Presinal indicated that the youth's parent will not transfer the insurance from another county and they can't get the medications. Facility is pursuing another placement for the youth. The last report reviewed was dated 10/2/2025 and was involving two clients possibly engaging in sexual activities on campus and one youth not having Plan B medication available. The Plan B medication was provided by Planned Parenthood and the sexual activity was deemed to have happened off campus (if at all). An exit interview was conducted with Jeremiah Presinal and no deficiencies were cited. A copy of this report was given to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Senior Director of Residence Jeremiah Presinal (SDR). The purpose of the visit was to follow up on an incident report with the facility. The incident occurred on 03/07/26, and the report indicated staff engaged in a 'standing mid-level hold'. LPA inquired what the nature of the hold was and if it is part of their Emergency Interventions. SDR stated that the terminology for that hold is Standing Low Level Restraint, which is an approved one-person restraint. SDR provided documentation of approved methods from CPI, which is the Emergency Interventions training used at the facility. An exit interview was conducted with Jeremiah Presinal and no deficiencies were cited. A copy of this report was given to the facility.


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On 3/11/2026, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced complaint investigation visit at the facility. LPA met with Jeremiah Presinal and Penn Chourre. The purpose of the visit was to deliver an amended copy of the report for the investigation of the above allegations. The original date of the initial report was 02/05/2026. There was no change in the findings. During the course of the investigation, LPAs Hall and Bertoli inspected the facility, reviewed records, and conducted confidential interviews regarding a fight that occurred between two youth on 9/23/2025. Confidential interviews indicated that the staff intervened promptly and that the injured youth was offered medical care, but declined until the next day, when staff encouraged them to seek treatment. During the course of the investigation, LPA Bertoli obtained inconsistent statements on staff treating minors with respect and being coerced. Lastly, LPA Bertoli attempted to contact the involved parties and the authorized representative, but was unsuccessful. Therefore, LPA Bertoli was unable to prove or disprove the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are Unsubstantiated. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of completing an Annual/Random Inspection and met with Manager of Residence Jeremiah Presinal, who assisted with the inspection. Disaster Preparedness and Emergency Interventions were reviewed and 3 staff and 3 clients were interviewed. The Care Tools domains for staff and client files will be completed at a later date. An Advisory Note was given regarding Disaster Preparedness drills. An exit interview was conducted and a copy of this report was left with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of continuing an Annual/Random Inspection and met with Senior Director of Residence Jeremiah Presinal. The facility was inspected and found to be clean, safe, and sanitary. Five staff files and five client files were reviewed at the administration office and they were found to be complete. LPA is issuing an Advisory Note for outdated Personal Rights forms and Staff Clearance documentation. The remaining Care Tools domains were completed, which concluded the Annual Inspection. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left with the facility.


facility_name: HARVESTING HEARTS GROUP HOME

raw_content:
Investigation Findings:
13On September 25, 2024, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA to conduct an unannounced inspection and met with Facility Manager Monique Jones. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the above allegations. During the course of the investigation, LPA conducted confidential interviews, reviewed files, and obtained pertinent documentation. Based on interviews and documents reviewed, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Monique Jones at the conclusion of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Monique Jones


raw_content:
Investigation Findings:
13On May 21, 2025, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA to conduct an unannounced inspection and met with Direct Care Staff Amanda Ross. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the above allegations. During the course of the investigation, LPA conducted confidential interviews, reviewed files, and obtained pertinent documentation. Based on interviews and documents reviewed, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Amanda Ross at the conclusion of the inspection via email due to printer error. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Amanda Ross


raw_content:
Investigation Findings:
13On July 2, 2025, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA to conduct an unannounced inspection and met with Facility Representative Amanda Ross. The purpose inspection was to deliver the findings for the above complaint allegation. The Department has investigated the above allegation. During the course of the investigation, LPA conducted confidential interviews, reviewed files, and obtained pertinent documentation. Based on interviews and documents reviewed, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to James Jones and Amanda Ross at the conclusion of the inspection via email due to printer error. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan 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


summary: Facility Evaluation

raw_content:
Narrative:
On 5/19/2023, Licensing Program Analyst (LPA) conducted a Technical Assistance Meeting (TA) via Microsoft Teams. Present from Harvesting Hearts was Licensee James Jones (LS). During the TA, the entirety of the revision letter, section A1-A13, B1-B18, and The Program Narrative/Statement part 3-29 was reviewed and discussed. LS had questions regarding the Partnership Agreement/Articles of Incorporation and if LS could request a DBA for the name Harvesting Hearts. LPA discussed in-service staff training, documentation of job shadowing, initial and annual review of psychotropic medication training, reviewing of children's personal rights, and documentation of training evaluation. Financial requirements were discussed and an updated LIC 401 will be submitted to LPA for a second review. LS had concerns regarding the amount of sufficient financial resources needed to operate the facility. LS will surrender Adult Residential Facility to conduct a fire inspection with the Fire Marshall. The Adult Residential Facility shares the same address as the prospective facility for Harvesting Hearts Group Home. LS disclosed to LPA Galvan the revisions are currently being worked on. The Application timeline and process were discussed during the TA. The department and the applicant/licensee agreed on a due date of June 10, 2023, for corrections to be submitted via email with highlighted changes.

met_with: James Jones


summary: Facility Evaluation

raw_content:
Narrative:
On July 14, 2023, the Component II Orientation was conducted by Licensing Program Analyst (LPA) Vanessa Galvan with Applicant, James Jones. The following was addressed and discussed: · The program expectations and daily operations. · Review of the second revision letter. The following will be updated: A5. Affidavit regarding Client/Resident Cash Resources, A9. Financial Information Release & Verification, A10. Personnel Report, A11. Personnel Record, A13. Criminal Record Statement, A14. Emergency Disaster, A16. Local Fire Inspection Authority Information, B1. Partnership Agreement/Articles of corporation, B2. Verification of Administrator/Director Qualifications, B5. Personnel Policies, B6. In-service Training for Staff, Part 4. Planned Activities/Use of Community Resources, Part 5. Special Services/Programs Offered, Part 6. Medical/Dental, Part 11. Visitation, Part 14. Emergency Intervention Plan, Part 15. Runaway Plan, Part 22. Staff Qualifications, Part 24. In-service Training for Staff/Administrator · Submit Application to Guardian to associate staff. · All corrections and updates will be completed by 8/04/2022. If applicants need an extension, applicant can contact LPA Galvan for an extension The pre-licensing inspection is tentatively scheduled for 08/01/2022 at 10: AM. The facility is located at E. Race Ave, Visalia, CA, 93292. A copy of this report was provided to James Jones.


summary: Facility Evaluation

raw_content:
Narrative:
On August 14, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts in Visalia, CA. The purpose of the visit is to conduct a pre-licensing Facility Inspection. LPA was met at the facility by Applicant/Licensee, James Jones and Facility Manager, Monique Jones. LPAs toured the facility and observed the following listed below. 1. The staff and client files will be locked in the hallway cabinet. 2. In the laundry cabinet is where chemicals, disinfectants, and cleaning products are stored in a locked and inaccessible to clients. 3. In the hall closet LPA observed a fire extinguisher. 4. In the hall cabinet LPA observed a first aid kit including all required items and first aid manual are included in the kit. 5. In the kitchen LPA observed well operating refrigerator. The refrigerator temperature is 37 degrees and freezer temperature are -1 degrees. The facility maintained a trash can with a lid in the kitchen. 6. The dining room has a table with chairs to accommodate the number of clients. 7. The house has three bedrooms- four non-ambulatory/ambulatory, two single occupancy and one bedroom double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. 8. The facility has adequate storage space and furniture. Continued on Page 2... Continued from Page 1... 11. Adequate food storage space observed. Perishable and non-perishable foods will be available before client are placed in the facility. 12. Facility has two full restrooms, and all are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees. All restrooms are stored with hand soap, toilet paper, and paper towels. 13. The temperature of the facility was a comfortable temperature of 75 degrees. 14. Facility has extra towels and linens for all clients. 15. The home has operating smoke alarms and a carbon monoxide detector. 16. The facility does not have a firearm or ammunition. Pending Items and documentation needing to be completed: · Fire clearance · One box/container with lock for room temperature medication and one box/container with lock for refrigerated medication. Both boxes/containers made inaccessible to clients. · Garage- clean-up of garage, removal of unused vehicle, refrigerator plug in. · Bedroom 2- removal of supplies in closet. · Have sharps, knives, dangerous kitchen objects inaccessible to clients. · Posting of Fire Clearance and Emergency Disaster Plan in common. · Lock for gate storing lawn care supplies. · Agency will make sure all staff receives a background clearance with FBI, CAIC, and DOJ and are associate in Guardian. · Emergency Disaster/Mass causality plan. · Posting of weekly menu. · LPA question about staff office This report was discussed and reviewed. A copy of this report was provided to James Jones.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On August 25, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts in Visalia, CA. The purpose of the visit is to conduct a follow-up pre-licensing Facility Inspection. LPA was met at the facility by Applicant/Licensee, James Jones and Facility Manager, Monique Jones. LPA Galvan toured the facility and observed the following corrections listed below. · Fire clearance has been completed and cleared by the fire inspector. · The facility has one box/container with lock for room temperature medication and one box/container with lock for refrigerated medication. Both boxes/containers are made inaccessible to clients. · The Garage has been clean, free from hazards and obstructions. · Bedroom 2 is equipped with storage and closet space for clients. · Sharps, knives, dangerous kitchen objects are inaccessible to clients. · The Emergency Disaster Plan, weekly menu, fire clearance are posted in a common for review. · The gate storing lawn supplies was locked and made inaccessible to clients. Agency will make sure all staff receives a background clearance with FBI, CAIC, and DOJ and are associate in Guardian. This report was discussed and reviewed. A copy of this report was provided to James Jones.


summary: Facility Evaluation

raw_content:
Narrative:
On October 25, 2023, Licensing Program Analyst (LPA) Vanessa Galvan conducted a case management to obtain documents. LPA was met by Facility Manager, Monique Jones. LPA obtained a new revised version of the program statement. This report was discussed and reviewed. A copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On May 15, 2024, Licensing Program Analyst (LPA) Vanessa Galvan traveled to the Harvesting Heart Group Homes located in Visalia, CA, to conduct an unannounced Case Management and met with Facility Manager, Monique Jones. The purpose of the inspection is to discuss an incident report that was submitted to the department on 05/14/2024 regarding client 1 (C1) and a review on how to properly fill out and submit an LIC624. Between the dates of May 12, 2024, and May 13, 2024, C1 was exhibited disruptive behaviors including yelling, cursing, and throwing objects. C1 refused phone calls from family and medical appointments. Teacher contacted the facility and informed facility representative that C1 made a report to their bus driver regarding the facility. LPA obtain additional information from the facility manager regarding the incidents that occurred. LPA discussed with the Facility manager reporting requirements, the need to provide details of incident, timeframes on reporting incident(s), and reviewed the LIC 624 and LIC 624LE. No deficiencies observed or cited during the inspection. An exit interview was conducted, a copy of the report and LIC 811 were discussed and provided to Monique Jones at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On June 12, 2024, Licensing Program Analysts (LPAs) Vanessa Galvan and Brinae Pointer traveled to Harvesting Hearts located in Visalia, CA to conduct a post-licensing inspection. The facility was licensed on December 8, 2023. LPA were met at the facility by Administrator Queen Jones and Licensee James Jones. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. LPA reviewed three staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, one House Manager, and one Direct Support Professional/house manager. LPA will need to return to the facility to review client files and conduct staff and client interviews. There were no deficiencies or citations issued today. A copy of this report was left with James Jones at the conclusion of the inspection.

met_with: Queen Jones & Monique Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 06/27/2024, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts located in Visalia, California to conduct an unannounced visit and met with Licensee, James Jones. The purpose of the visit was to complete the post licensing inspection that was started on 6/12/2024. LPA reviewed 2 client files. All required documentation were in the client files. LPA conducted interview with 1 client and 2 staff. LPA addressed allowance logs, centrally stored medication, and emergency disaster preparedness file. No deficiencies were issued or observed at this time. A copy of this report was given to James Jones and Queen Jones at the conclusion of this inspection.


summary: Facility Evaluation

narrative: On 06/27/2024, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts located in Visalia, California to conduct an unannounced visit and met with Licensee, James Jones. The purpose of the visit was to complete the post licensing inspection that was started on 6/12/2024. LPA reviewed 2 client files. All required documentation were in the client files. LPA conducted interview with 1 client and 2 staff. LPA addressed allowance logs, centrally stored medication, and emergency disaster preparedness file. No deficiencies were issued or observed at this time. A copy of this report was given to James Jones and Queen Jones at the conclusion of this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2024, Licensing Program Analyst (LPA) Vanessa Galvan traveled to the Harvesting Heart Group Homes located in Visalia, CA, to conduct an unannounced Case Management and met with Facility Manager, Monique Jones. The purpose of the inspection is to discuss an incident. LPA conducted a confidential interview and completed a physical plant inspection. LPA observed in client 1's (C1) bedroom no locks on the bedroom window or door. LPA observed there to be an adequate supply of perishable and non-perishable foods. No deficiencies observed or cited during the inspection. An exit interview was conducted, a copy of the report and LIC 811 were discussed and provided to Monique Jones at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On December 4, 2024, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA to conduct an annual inspection. The facility was licensed on December 8, 2023. LPA were met at the facility by Administrator Queen Jones, Facility Manager Monique Jones, and Licensee James Jones. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. LPA reviewed two staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, one Facility Manager, and one Direct Support Professional/house manager. Continued on Page 2... Continued from Page 1... LPA reviewed 2 client files. All required documentation were in the client files. LPA conducted interview with 0 clients (see LIC 812 for additional information) and 2 staff. LPA addressed information regarding Medication documentation, Cash Resource Receipt, Policies, Disaster Plan/Binder, updated personal rights, staff files, and board meeting minutes. No deficiencies were issued or observed at this time. There were no deficiencies or citations issued today. A copy of this report was left with Monique Jones at the conclusion of the inspection.

met_with: James Jones, Monique Jones, Queen Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 01/17/2025, Licensing Program Analyst (LPA) Vanessa Galvan met with the Facility's Administrative Assistant (AA) Amanda Ross. The purpose of the meeting was to provide Technical Assistance (TA) on files and regulations. During the TA meeting LPA and AA discussed regulations referencing clien files, staff files, and training requirements. LPA reviewed facility forms and policies with AA. LPA provided assistance with navigating Guardian. A copy of this report was discussed and provided to Amanda at the conclusion of the meeting.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Briana Placencia on January 27, 2025 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Queen Jones, Administrator and inspected the facility inside and out. LPA reviewed 1 child record and 2 staff personnel files on site at the facility. LPA reviewed 1 child psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA was unable to conduct any interviews due to the child currently on psychotropic medication due to the child being in school. LPA will interview child at a later time. LPA provided a copy of this licensing report to Queen Jones, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Queen Jones, Administrator

met_with: Queen Jones


summary: Facility Evaluation

raw_content:
Narrative:
On October 9, 2025, Licensing Program Analyst (LPA) Vanessa Galvan traveled to the Harvesting Heart Group Homes located in Visalia, CA, to conduct an unannounced Case Management and met with Direct Care Staff, Amanda Ross. The purpose of the inspection is to discuss an incident. LPA conducted a confidential interview and completed a physical plant inspection. LPA gathered additional information regarding the incident that took place on 09/28/2025. LPA was informed that Client 1 (C1) and Client 2 (C2) were asleep in their separate bedrooms. Staff 1 (S1) went to the bathroom, while using the bathroom S1 heard a scream coming from C2's bedroom. Immediately, S1 intervened and redirected C1 out of C2's bedroom. C2 was observed for any injuries and if there was a need for medical attention. C2 did not need medical attention. Due to supervision concerns for C1, C1 will now have a 1:1 staff to ensure safety for C1 and other clients. No deficiencies observed or cited during the inspection. An exit interview was conducted, a copy of the report was discussed and provided to Amanda Ross at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On December 17, 2025, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA and met with Administrator Queen Jones, Facility Manager Monique Jones, and Administrator Assistant Amanda Ross. The purpose of the unannounced inspection is to conduct the Annual Inspection. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. There are four ambulatory bedrooms, single occupancy, and two bathrooms all located on one single level. Bedrooms are accommodated with required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full bathrooms, and they are in operable condition. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature. All facility smoke detectors are in appropriate working order, and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and 4 chairs accommodating all clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the hallway cabinet and is complete with all first aid items. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. There are no firearms or weapons or ammunition stored at the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed five staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, two Facility Manager, and two Direct Support Professional/house manager. LPA reviewed three client files. All required documentation were in the client files. LPA conducted interviews with no clients (see LIC 812 for additional information) and two staff. On this date LPA reviewed the Guardian Roster and confirmed all staff on the LIC. 500 had a background clearance to work at the facility. LPA addressed information regarding Annual Training Logs. The facility was cited for Title 22, Division 6, Chapter 5, Article 06. Continuing Requirements, Section Personnel Records 84066(b)(1), Title 22, Division 6, Chapter 1, Article 06. Continuing Requirements, Section Personnel Records 80066(a)(10), 80066(a)(11), and Section Health Related Services 80075(f). This report and the appeal rights were discussed and provided to Queen Jones at the conclusion of the inspection.

met_with: Amanda Ross, Queen Jones, Monique Jones


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On October 9, 2025, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Heart Group Homes, located in Visalia, CA, to conduct an unannounced Case Management and met with Direct Care Staff member Amanda Ross. The purpose of the inspection is to discuss an incident that occurred. During the physical plant inspection, the LPA observed the following: The living room light switch was broken. In bedroom one, there was a mattress with visible urine stains and a persistent odor of urine. In bedroom two, the blinds were not properly secured to the window frame, and the window lacked a screen. Multiple deficiencies were noted in bedroom three: the mattress was placed directly on a low bed frame without a box spring, the walls exhibited physical damage, the room was inadequately lit due to the absence of lighting fixtures, electrical and light switch outlets lacked protective plates, the dresser was structurally compromised, and pillows were absent. Additionally, the flooring in this room was lifting, and the adjoining bathroom had a toilet basin without a lid cover alongside evident wall damage. Finally, observations in the backyard revealed the presence of dog fecal matter on the lawn, resulting in a pronounced odor and a significant production of flies. The facility is being cited for Title 22, Division Chapter Article 07. Physical Environment, section Buildings and Grounds (a) and (1), Furniture, Fixtures, Equipment, and Supplies (b) and (d), Furniture, Fixtures, Equipment, and Supplies (e)(3), Title 22, Division 6, Chapter 5, Article 07. Physical Environment, section Fixtures, Furniture, Equipment and Supplies (c)(1). (See attached LIC809-D for additional information. An exit interview was conducted, a copy of the report and the appeal rights were discussed and provided to Amanda Ross at the conclusion of the inspection.

Deficiencies:
84088: (1) An individual bed maintained in good repair; equipped with good springs and a clean mattress; and supplied with pillow(s) which are clean and in good repair.

title: Fixtures, Furniture, Equipment and Supplies (c)...readily available to each child ...


summary: Facility Evaluation

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Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Briana Placencia and Melissa Renovato on January 29, 2026 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPAs met with Queen Jones, Administrator and inspected the facility inside and out. LPAs reviewed 2 child records and 2 staff personnel files on site at the facility. LPAs reviewed 2 child psychotropic medications and medication records. LPAs interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPAs were unable to conduct any interviews as the children currently on psychotropic medication are at school. LPAs will interview children at a later time. LPAs provided a copy of this licensing report to Queen Jones, Administrator. Licensee was issued a Technical advisory on todays visit. LPAs conducted exit interview with Queen Jones, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 deficiency

raw_content:
Investigation Findings:
13On April 14, 2026, Licensing Program Analyst (LPA), Melissa Renovato conducted an unannounced visit to the Harvesting Hearts Group Home in order to deliver the findings of the above allegation and met Queen Jones, Administrator and Monique Jones, Facility Manager. On March 4, 2026, the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the information obtained, there is a preponderance of the evidence to prove the above allegation occurred therefore this allegation is Substantiated. The Facility was cited for Group Homes Chapter 5, Subchapter Emergency Intervention in Group Homes, Section 84365. See LIC9099D. Plans of Corrections were reviewed and developed with Queen Jones. A copy of this report and appeal rights were provided at the conclusion of the inspection. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Melissa Renovato 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: HARVESTING HEARTS GROUP HOMEFACILITY NUMBER: 547207234

Deficiencies:
84365: (a) No facility personnel must use emergency intervention techniques...unless the training instructor has certified...that the facility personnel have...completed the emergency intervention training required in Section 84365(b). (1) All...facility personnel who use or participate in emergency interventions...must complete the training.

title: Emergency Intervention Staff Training


facility_name: HATTERAS

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
LPA assessed that all statements were congruent with the method of interventions implemented to ensure that the facility provided proper supervision to support and met the needs of children in placement. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has determined that the allegations of Neglect/Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited An exit interview was conducted and the report was provided to the Program Director on 07/22/2022.

Investigation Findings:
13On July 22, 2022, at 10: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the investigation and to deliver the finding. LPA-Gray conducted a Health and Safety asssement of the facility. During the investigation, LPA-Gray interviewed and accounted for all available relevant parties; and gathered pertinent information in reference to the two (2) allegations listed in the complaint. The facility denied the allegations and there were no creditable statements obtain from clients due to phasing out of the program. Information and records obtained revealed that there were no statements or documented evidence to support the allegations that the facility " Staff failed to meet the clients' needs, Staff failed to prevent clients' from self-harm" ever occurred. The internal Investigation revealed that the facility provided evidence of Therapeutic Treatment and various program intervention procedures to prevent self-harm. The staff provided proper supervision and took precautionary measures to ensure the health and safety of clients in placement. Evidence also show that the facility met the requirements of Staff to client Ratio. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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 34-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, N. Continental Blvd. #290B FACILITY NAME: HATTERASFACILITY NUMBER: VISIT DATE: 07/22/2022

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

met_with: PROGRAM DIRECTOR


summary: Complaint Investigation - Substantiated

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Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed all involved staff, clients and witnesses. LPA Jones-Steward reviewed intake assessment and treatment plan for C1. Clients and Staff both report that staff were unaware that the clients AWOLED or that C1 did not return. Both staff persons who were interviewed stated that they did not notice that clients were missing until the next morning when the mother of one of the clients called to report that her daughter was i the hospital. Both staff stated that they overlooked reporting the hospitalization to Community Care Licensing.. Based on the available information, the above allegations are substantiated. Substantiated means that there is a preponderance of evidence that an allegtion is true. Facility was cited for Lack of Supervision (80078) and failure to meet Reporting Requirements.(80061) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: HATTERASFACILITY NUMBER: 198209669

met_with: Toni Jackson-Rainey, Operations Manager

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Facility was cited for lack of a posted menu 84076 (b), requiring clients to participate in meal preparation 84076 (c) (5) (C), and failure to maintain the physical plant in good repair including a missing pantry cabinet, a cracked bedroom door, and a hanging emergency exit sign 80087 (a) (2). During a walk through on 10/1/ LPA and LPM observed the fixed emergency exit sign and was informed of pending repairs for the cracked door and missing cabinet door. During the walk through on 10/1/ LPA and LPM also observed a mattress that was longer than the frame and a missing shower door in the bathroom by the entrance. Hatteras staff informed LPA and LPM that they have order a new shower door and will order a new mattress. Exit interview to be completed with staff and a copy of the appeal right issued.

Investigation Findings:
13On 10/01/2024 at 10:15 am Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith investigated the above allegations. LPA and LPM interviewed involved staff and clients. LPA and LPM also conducted a walk-through inspection of the facility on 9/16/24. Interview evidence revealed a lack of a monthly written and posted menu since the facility chef resigned on 8/15/24. Since then clients are being required to participate in meal preparation for breakfast, lunch, and dinner.Interview statements reveal that some staff do assist clients in preparing some of their daily meals. During the walk-through LPA and LPM observed a crack in a bedroom door, a kitchen cabinet without a door, and an exit sign hanging loosely from the celling. Based on the available information LPA and LPM gathered from interviews and observation, the preponderance of the evidence standard has been met, therefore the allegations are found to be substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Reagan Cohen 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: HATTERASFACILITY NUMBER: VISIT DATE: 10/01/2024

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

met_with: Daniel Samson


summary: Facility Evaluation

raw_content:
Narrative:
On November 5, 2021 at 9: AM, Licensing Program Analyst (LPA) Zena Phillips arrived at the above facility, for the purpose of conducting a Annual inspection. LPA met Sydney Berry/Facility Manager & Navdeep Shagoo/ Quality Improvement who granted access into the facility, and who provided a copy of LIC 500 and LIC 9020. A tour of the entire physical plant inside and out was provided by Sydney Berry/ Facility Manager and Navdeep Shagoo/Quality Improvement. This facility is designed to accept private placement to provide care/supervision for six (6) male and female, ambulatory only clients, ages 12-17 years. The home is set up as follows: This is two story, four (4) bedroom, four (4) bathroom home located in a residential neighborhood. There is a swimming pool on the premises that has a fence around the pool with a lock and a latch to make it inaccessible to the clients. There is also a patio next to the pool with a table and adequate amount of seating. Downstairs (main floor) has the following: There is a living room with a sectional sofa, three (3) bean bags, a flat seating that can seat two (2) with a large TV. There is a gym with exercise equipment, an intake room, two (2) therapists rooms, a storage room and a laundry room. Dining room has 11 seats with games. There is a kitchen with non-perishable foods for one week. There is an emergency doorway to facilitate evacuation from the intake room, dining room sliding door, living room and dining door. There are emergency exit signs on each exit. LPA observed two fire extinguishers in the downstairs to the right of the kitchen fully charged. Bedroom #1: Is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting. . Bedroom #2: Is equipped with one (1) twin size bed. There are adequate drawers, closet space, and lighting. Facility Manager stated room 2 is currently not occupied. Report continued on LIC 809-C Bedroom #3: Is equipped with two (2) full size beds. There are adequate drawers, closet space, and lighting. This room has an attached bathroom. Bedroom #4: Is equipped with one (1) twin size bed. There are adequate drawers, closet space, and lighting. LPA observed all bedrooms windows and screens in good repair. Upstairs (2nd floor) has an area that the facility calls a classroom with 6 apple desktop computers, adequate amount of seating, a locked fireplace that is disabled, and an attached bathroom and a medication room that is locked and only accessible to employees. Facility is clean, safe, sanitary, and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons are made inaccessible. There are no firearms/dangerous weapons. Temperatures in rooms that clients occupy are maintained between 68 and 85 degrees (F). Hot water temperatures are maintained between 105 and 120 degrees (F). Children in care will be supervised and protected at all times; Children will attend school, extracurricular, cultural, and personal enrichment activities. All smoke detectors were tested and are operating properly in the home at the time of visit. Carbon Monoxide alarms were tested and functional in the home at the time of the visit. Facility has non-perishable foods for one week and will have perishable foods for two days, provides nutritious snacks between meals. LPA conducted staff interviews with present staff and will complete staff interview on next inspection visit. Clients were not available for interview due to school and therapy session, LPA will conduct interviews on next inspection. Exit interview was conducted.Navdeep Shagoo/Quality Improvement was advised LPA Phillips will return to review client and staff files. A copy of this report is discussed and will be emailed to facility manager

met_with: Sydney Berry/Facility Manager/ Navdeep Shagoo/Quality Imporovement


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2021 at 9: AM Licensing Program Analyst (LPA') Zena Phillips, made an unannounced visit to Hatteras Group Home to continue the Annual Inspection. LPA met with Sydney Berry/Facility Manager who granted access to the facility. LPA Phillips met with Dr Evelyn Vasquez who provided access to the electronic Clients Records. LPA met with Clara Mahmoudi (RN) who provided access to Client medications stored in double locked closet upstairs. LPA met with Lesky Santos- Kiaee Director of Human Resources who granted access to the electronic Staff records. LPA reviewed the following during the inspection: Staff Records Review; Clients Records Review and Medication Review. LPA interviewed all five (5) Clients that were present. Emergency Disaster Mass Casualty Plan: Current and available for review There were no deficiencies cited at this time Exit Interview was conducted, and a copy of this report was left at facility

met_with: Sydney Berry/Facility Manager/ Navdeep Sagoo/Quality Imporovement


summary: Facility Evaluation

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Narrative:
On November 21, 2023, at 10: AM, (LPA) Licensing Program Analyst - Dennis Jarmin made an unannounced visit to Hatteras Group Home to conduct the 2-year Annual Inspection. LPA met Kaz Katseanes (Assistant Regional Program Director) and Toni Rainey (Director of Operations) who granted access to the facility and provided a copy of LIC 500 and LIC 9020. LPA then inspected the entire physical plant of the facility. The Group Home is licensed to provide care/supervision up to six (6) male and female children ages 12-17, Ambulatory only. There is a swimming pool on premises that meets regulations. Home composition: This is a two story, four (4) bedroom, four (4) bathroom home located in a residential neighborhood. There is a swimming pool on the premises that has a fence around the pool with a lock and a latch to make it inaccessible to the clients. There is also a patio next to the pool with a table and an adequate amount of seating. Downstairs (main floor) has the following: There is a living room with a sectional sofa, three (3) bean bags, a flat seating that can seat two (2) with a large TV and a fireplace that is disabled and inaccessible. There is a gym with exercise equipment, an intake room, two (2) therapists' rooms, a storage room, and a laundry room. The dining room has 10 chairs available for seating. The kitchen has several cabinets and knives are stowed properly, and bleach and cleaning materials are locked on one of the upper cabinets. There is a large refrigerator and freezer with an appropriate temperature gauge and an operable stove/oven burner for cooking. There is an emergency doorway to enable evacuation from the intake room, dining room sliding door, living room, and dining door area. The home is equipped equipped with emergency exit signs on each exit. LPA observed two fire extinguishers downstairs to the right of the kitchen fully charged. Bedroom #1: This is equipped with two (2) twin-size beds. There are adequate drawers, closet space, and lighting. Bedroom #2: This is equipped with one (1) twin-size bed. There are adequate drawers, closet space, and lighting. The facility Manager stated room 2 is currently not occupied. Bedroom #3: This is equipped with two (2) full-size beds. There are adequate drawers, closet space, and lighting. This room has an attached bathroom. Bedroom #4: Is equipped with one (1) twin-size bed. There are adequate drawers, closet space, and lighting. LPA observed all bedroom windows and screens were in good repair. Upstairs (2nd floor) - Designated as the classroom is equipped with Apple desktop computers, adequate amount of seating, and an attached bathroom and a medication room that is locked and only accessible to employees. The facility is clean, safe, sanitary, and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons are made inaccessible. There are no firearms/dangerous weapons on site. Temperatures in rooms that clients occupy are maintained suitably between 68 and 85 degrees (F). Hot water temperatures are maintained between 105 and 120 degrees (F), however, a slight deviation in temperature was noted during LPA's walk through. Maintenance was called to repair the hot water immediately and work order was provided to LPA. Children in care are supervised and protected at all times. The youths attends school and participates in extracurricular activities including cultural and personal enrichment program. All smoke detectors were tested and operable including the two carbon monoxide detectors operating properly at the time of the inspection. The facility has 7 days non-perishable foods and 3 days perishable, and provides nutritional snacks between meals. LPA conducted (3) staff interviews and (2) client interviews and all required posting were met (meal plan, daily activities, required licenses and regulations, personal rights and emergency disaster plan) that are posted in the common area readily accessible to clients. Exit interview was conducted, and a copy of this report is discussed and will be emailed to the Assistant Regional Director.

met_with: KAZ KATSEANEF, ASST REGIONAL


summary: Facility Evaluation

raw_content:
Narrative:
On 9/16/ Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith arrived at the Hatteras facility and conducted an unannounced inspection regarding a case management-other inspection. During the course of the inspection LPA and LPM witnessed a sinking bed for one of the clients. LPA and LPM inspected the bed and found that under the mattress the middle bar of the bed frame was not attached to the rest of the bed frame. LPA and LPM informed and showed Director of Operations (DO) Toni Jackson-Rainey the bed frame and the unconnected pieces. DO said they would take the next steps to address and fix the bed. Also while reviewing the personnel report LPA and LPM found staff on the roster that could not be conformed to have criminal record clearance. LPA and LPM informed DO that all staff must be cleared and any staff not found with clearance can not work in facility. LPA will check guardian to ensure staff clearance and will follow up with DO tomorrow. Exit Interview completed with staff Toni. for Advisory Technical Violation. Report will be emailed to Toni.

met_with: Toni Jackson-Rainey


summary: Facility Evaluation

raw_content:
Narrative:
On 10/01/2024 at 10:00 am Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith arrived at Hatteras for the purpose of an unannounced case management deficiency inspection. LPA and LPM met with staff to discuss criminal record clearances. On 9/16/24 licensing staff conducted an unannounced visit and learned that several staff working at the facility were not associated to Hatteras. LPA and LPM researched guardian and determined that several staff worked in the facility without being associated. Although staff was associated to Calenda or Ladrillo they must be associated to Hatteras as well prior to working in the facility. Based on interview evidence and records review LPA and LPM discovered that five employees did not have their criminal record clearances transferred to the Hatteras facility. The following deficiency is being cited for violating of California Code of Regulations Title 22, Division Regulation 80019 (e) (3) criminal record clearance. (see page D) Exit interview completed and appeal rights issued. Report will be emailed to staff and LPA and LPM will also forward PIN regarding camera use.


facility_name: HAVEN OF WALNUT CREEK, LLC, THE

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
PAGE Multiple staff demonstrated the patting that they stated the resident likes, and LPA observed the patting to be less forceful than the patting captured in the video and the resident to not turn their head away or appear bothered at all by the patting. LPA determined that the pat captured in the video was done with excessive force. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personal Rights. See LIC 9099-D. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator, whose signature on this form confirms receipt.

Investigation Findings:
13On 11/7/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint investigation visit regarding the above allegation. LPA met with Administrator Juvy Golub and Facility Manager Rahanat Abubakar and informed of the purpose of the visit. During the visit, confidential interviews with 7 staff were conducted. LPA attempted an interview of the involved reseident, but due to limited verbal/communication, LPA was unable to obtain a statement. All other residents are nonverbal. The video evidence submitted with the complaint was played for Administrator and Facility Manager. The video shows staff S1 hit a resident in the face and the resident to immediately turn their face away. Based on staff interviews, the resident likes when staff pat the resident's face due to a skin-picking condition the resident has that results in the skin itching but not being safe to scratch. LPA reviewed the involved resident's records and observed medical records reflecting the skin-picking behavior. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HAVEN OF WALNUT CREEK, LLC, THEFACILITY NUMBER: VISIT DATE: 11/07/2024

met_with: Administrator Juvy Golub, Facility Manager Rahanat Abubakar


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

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

met_with: Aida Moredo - Facility Manager


raw_content:
Investigation Findings:
13On 09/09/25 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection visit and met with Aida Moredo, Facility Manager. The purpose of the visit was to deliver findings for the above complaint allegations. Based on confidential interviews and record review, the preponderance of evidence standard has been met. Therefore, the allegations that staff hit another staff in the facility and did not create a safe and healthy environment for clients in care, and that the Administrator did not follow reporting requirements regarding an incident that occurred at the facility, are SUBSTANTIATED. These findings are violations of the California Code of Regulations (CCR), Title 22, Division 6, Chapter 5, Section 84072(d)(1) - Personal Rights, and Chapter 1, Section 80061(b)(1)(E) - Reporting Requirements. Please refer to LIC 9099-D for additional details. As this home is no longer operating under Children's Residential, a Plan of Correction (POC) was not required. At this time, two deficiency has been cited with no POC needed. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Aida Moredo, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HAVEN OF WALNUT CREEK, LLC, THEFACILITY NUMBER: 075650139

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


raw_content:
Investigation Findings:
13On 10/07/25 at 3: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection visit and met with Rahanat Abubakar, Facility Manager. Juvy and Howard Golub also attended this visit. The purpose of the visit was to open and deliver findings for the above complaint allegation. Based on confidential interviews and review of video evidence, the preponderance of evidence standard has been met. Therefore, the allegation "Staff violated personal rights of client", is SUBSTANTIATED. These findings are violations of the California Code of Regulations (CCR), Title 22, Division 6, Chapter 5, Section 84072(d)(1) - Personal Rights. Please refer to LIC 9099-D for additional details. As this home is no longer operating under Children's Residential, a Plan of Correction (POC) was not required. At this time, one deficiency has been cited with no POC needed. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Rahanat Abubakar, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HAVEN OF WALNUT CREEK, LLC, THEFACILITY NUMBER: 075650139

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

met_with: Rahanat Abubakar, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday 12/14/21 at 11:56AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to conduct a required annual inspection. LPA met with Facility Manager Mark Pons and informed of the purpose of the visit. The CARES Inspection Tool was used to conduct the inspection. The facility and grounds are clean, well-maintained, and free of obstructions. There are no bodies of water, and there are no firearms on the premises, per Facility Manager. Food is within date and in a quantity to meet the needs of residents in care. Room temperature and hot water temperature measured within permitted range, at F and 105. F, respectively. Residents have individual beds with clean linens and mattress pads. Confidential interviews were conducted with both present staff. Residents were at school, and 3 of 4 are nonverbal. Facility, staff, and resident records were inspected and observed to be complete. The following items need to be addressed: 1) Resident R4 (See LIC Confidential Names, dated 12/14/21) file contained an incomplete LIC Record of Client's/Resident's Safeguarded Cash Resources. R4 receives county funding, which is not separated into a separate P&I fund as with Regional Center. However, LPA advises, per California Code of Regulations (CCR), Title 22, Section 80070, that cash resources similarly be logged on the LIC 405 to ensure that record is maintained. 2) Resident R3 file had a psychotropic medication, Trazodone, that was logged on the standard Medication Administration Record (MAR - LIC622A) rather than the Psychotropic MAR (PMAR - LIC622B). The facility did already have a psychotropic medication consent form signed by authorized representative. The log was otherwise complete and properly maintained. LPA advises, per CCR, Title 22, Section 84070, that the facility begin using the PMAR for this medication starting January 2022 so as to avoid confusing the records. 3) Resident records did not contain documentation of shared bedrooms. LPA advises, per CCR, Title 22, Section 84087, that the facility document whenever a bedroom is shared to ensure the arrangement is compatible and to maintain this documentation in the file of each resident sharing a bedroom. There are no citations. Three advisories were issued per California Code of Regulations, Title 22, Sections Client Records, Children's Records, and Buildings and Grounds. An exit interview was conducted, and a copy of this report was left with Facility Manager Mark Pons, whose signature on this form confirms receipt.

met_with: Facility Manager Mark Pons


summary: Facility Evaluation

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Narrative:
On 03/16/2022 at 10:00AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the above listed facility for the purpose of conducting the required annual inspection. LPA met with Mark Pons, Facility Manager, and conducted a walk-through of the facility. There were two staff members and zero clients present at the time of inspection. The facility currently has a census of four clients, one that is a non-minor dependent. The four clients are either fully or partially nonverbal. LPA reviewed the centrally stored medication log, four client files, five staff files, the personnel binder, and the emergency plan. LPA interviewed two staff members. LPA delivered a Technical Violation for CCR 84087(e) due to the lack of documentation on room sharing compatibility. LPA delivered a Technical Assistance for CCR 80066(a)(8) for the lack of duties specified within the staff files. LPA conducted a complete physical site inspection and found no deficiencies. The facility was clean, sanitary, and there was an adequate amount of food for all youth present. LPA toured the youth's rooms and found that they all had adequate space and necessities. LPA conducted an exit interview with Mark Pons at 1:30PM, whose signature confirms the receipt of this document.

met_with: Mark Pons


summary: Facility Evaluation

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Narrative:
On 04/19/2023 at 10:45AM, Licensing Program Analyst (LPA) Lisette Valenzuela conducted an unannounced visit to the above listed facility for the purpose of conducting the required annual inspection. LPA Valenzuela met with Mark Pons, Facility Manager, and conducted a walk-through of the facility. There were four (4) staff members and one client (C1) was present at the time of inspection. The client present is non-verbal. Another client (C2) came home from school during time of inspection. The facility currently has a census of four clients. Three clients are non-verbal, and one client is partially verbal. One of the clients is a non-minor dependent. LPA Valenzuela reviewed six (6) staff files, four (4) client files, LPA Valenzuela also reviewed the centrally stored medication log, the personnel binder, and the emergency disaster plan. LPA Valenzuela interviewed two staff members. LPA Valenzuela couldn't interview C1 due to client being non-verbal. LPA Valenzuela attempted to interview C2 who is partially verbal, but C2 was unsuccessful at responding to any questions. During physical plant inspection, no deficiencies were found. The facility was clean, sanitary, free of obstructions, and an adequate amount of food for all clients in care was present. Client bedrooms were clean, and had space for belongings and client necessities. LPA Valenzuela observed locked cabinet where all facility files and medication is store and kept. LPA Valenzuela cited one (1) deficiency for CCR 84087 (e) due to not having any documentation on bedroom sharing compatibility for clients. LPA Valenzuela also delivered a Technical Violation for CCR 80066(a) for not having staff files for a staff member present at the time of inspection. LPA Valenzuela conducted an exit interview with Mark Pons at 2:52PM, whose signature confirms the receipt of this document. LPA Valenzuela will email documents to Mark Pons, Facility Manager.


summary: Facility Evaluation

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Narrative:
On 03/07/2024 at 12:45 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Mark Pons, Facility Manager. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Facility Manager. LPA Rodriguez used the CARE Inspection Tool. There were four (4) staff members, and one client (C1) was present at the time of inspection. The client present is partially verbal. Two other clients (C2) and (C3) came home from school during time of inspection. The facility currently has a census of five clients. Four clients are non-verbal, and one client is partially verbal. Two of the clients are non-minor dependents. LPA Rodriguez reviewed six (6) staff files, five (5) client files, LPA Rodriguez also reviewed the centrally stored medication log, the personnel binder, and the emergency disaster plan. LPA Rodriguez interviewed three staff members. LPA Rodriguez couldn't interview any of the clients. During the physical plant inspection, no deficiencies were found. The facility was clean, sanitary, free of obstructions, and an adequate amount of food for all clients in care was present. Client bedrooms were clean and had space for belongings and client necessities. LPA Rodriguez observed the locked cabinet where all facility files and medication is stored and kept. LPA Rodriguez delivered one Technical Assistance for CCR 84070(c)(1), because two out of the five clients do not having an updated Needs and Services Plan. One of the clients came back after leaving for a year. The other client, the Facility Behavior Analyst is working on the new ISP for the client. An exit interview was conducted at 4:12 p.m., and a copy of this report was emailed to Licensee Juvy Golub, whose signature on this form confirms receipt.

met_with: Mark Pons, Facility Manager & Juvy Golub, Licensee


summary: Facility Evaluation

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Narrative:
On 06/05/2024 at 11:15 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and LPA Celeste Aparicio conducted an announced visit to the licensed facility. The purpose of this visit was to conduct the SB Psychotropic Medications Inspection. LPAs met with Mark Pons, Facility Manager. The facility currently had a census of five clients, one of the clients in care met SB484 inspection criteria. LPAs reviewed the client files and medication records for one client in care. Based on record review, LPAs observed there to be no PMAR or Centrally Stored Medication Log for one of the medications. LPAs delivered a Technical Violation for California Code of Regulations, Title 22, Section 84070(b)(13). At 1:25 p.m., LPAs observed Maricris Floro, Direct Care Staff to conduct a pill count of the psychotropic medications. LPAs did not observe deficiencies with the pill counts. LPAs met with Mark Pons, Facility Manager, and received four staff files. LPAs reviewed four staff files. LPAs found no deficiencies. LPAs conducted four staff confidential interviews. LPAs could not conduct the client interview due to the client being non-verbal. LPAs conducted a walk through of the facility. LPAs observed that the medications were kept in a locked cabinet inside of a locked room. This inspection is complete. LPAs conducted an exit interview with Juvy Golub, Administrator at 2:25 p.m. The signature confirms the receipt of this document.

met_with: Mark Pons, Facility Manager & Juvy Golub, Administrator


summary: Facility Evaluation

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Narrative:
On 11/7/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit regarding a deficiency observed at the facility. LPA met with Administrator Juvy Golub and Facility Manager Rahanat Abubakar and informed of the purpose of the visit. During an investigation at the facility, LPA conducted confidential interviews of currently employed staff. During the interviews, LPA observed that multiple staff were aware of their mandated reporter status and what that meant but were unfamiliar with their responsibility to report to outside agencies such as CPS, adult protective services, and the police directly if they observe abuse or neglect. Review of personnel records reflected that all staff had received recent training on mandated reporting and had signed an acknoweldgement of requirement to report child abuse. LPA is issuing an advisory to advise that staff be retrained during an in-house training where staff demonstrate their knowledge of reporting protocols. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator Juvy Golub, whose signature on this form confirms receipt.


summary: Facility Evaluation

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Narrative:
On Thursday, February 20th, 2025 at 10AM, a noncompliance conference was held to discuss compliance concerns at the facility. Licensee was informed of the purpose of the meeting. The specific areas of concern were discussed, and a corrective action plan was developed in consultation with Licensee. In attendance representing Licensee: - Howard Golub, Licensee - Juvy Golub, Licensee/Administrator In attendance representing the Department: - Helga Wong, Regional Manager - Isabel Diego, Licensing Program Manager - Mariah Hawkins, Licensing Program Analyst In attendance representing Regional Center: - Geff Go (Regional Center of the East Bay) - Michael Minton (Regional Center of the East Bay) The meeting adjourned at 12:50PM. A copy of this report was provided to Licensee.

met_with: Howard Golub, Licensee; Juvy Golub, Licensee/Administrator


summary: Facility Evaluation

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Narrative:
On 3/18/25 at 1:10PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced case management inspection at the facility in order to deliver notice of the immediate exclusion of a staff member. LPA met with Facility Manager Rahanat Abubakar and informed of the purpose of the visit. As a result of an investigation by the Department of Social Services, it has been determined that the individual S1 (See LIC Confidential Names) engaged in inimical conduct while working as a staff member at this licensed facility. Written notice of this immediate exclusion was provided to Facility Manager and S1 at this visit. S1 is a current staff member, and LPA explained to licensee that this immediate exclusion requires S1's immediate removal from the facility. No deficiency citations were issued at this inspection. An exit interview was conducted, and a copy of this report, the immediate exclusion letter, the LIC 811, and the licensee's appeal rights were provided to Facility Manager Rahanat Abubakar.

met_with: Facility Manager Rahanat Abubakar


summary: Facility Evaluation

raw_content:
Narrative:
On 3/18/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced required annual inspection. LPA met with Facility Manager Rahanat Abubakar and informed of the purpose of the visit. During the visit, LPA toured the facility site and observed the facility to be clean and maintained in safe and sanitary condition. Food supply is in quantity and quality to meet current clients' needs. Bedrooms provide individual beds, personal storage space, and clean linens. Facility license and personal rights are posted. LPA inspected 5 staff files and observed all files to be complete and contain required documentation. Staff training records reflect all staff are receiving the required hours of annual training on topics relevant to the served population. LPA provided technical assistance with Guardian background clearance procedures. LPA observed 2 nonverbal clients in care. LPA observed clients to be dressed in well-fitting, age-appropriate clothing with no apparent holes or stains, to be allowed free movement throughout the facility, to engage in activities with peers and staff, and to show no signs of discomfort around staff. Clients were provided an afternoon snack, and staff provided close supervision and engagement. A continuation inspection will be conducted in order to complete this inspection. No deficiency citations were issued at today's inspection. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Facility Manager Rahanat Abubakar.


summary: Facility Evaluation

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Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Alyssa Ng on 6/2/2022 at 10: AM. During the inspection, LPA Ng met with Mark Pons, Facility Manager and inspected the facility inside and out. Administrator Juvy Golub (ADM) later arrived at the facility. LPA interviewed 2 of staff on site at 10: AM. LPA interviewed 0 of children currently taking psychotropic medication at 10: AM. LPA reviewed 4 of staff personnel files on site at the facility at 11: AM LPA reviewed 3 of child's records on site at the facility at 11: AM. At 11: AM, LPA Ng and FM began the pill count for the three clients (refer to LIC811 for confidential names). There is a total of three out of four clients on psychotropic medication. When counting medications for C1, there were two pills that were missing from the pill bottle. The total pills that were supposed to be in bottle was 27. LPA Ng and FM counted 25 pills. Both FM and ADM recounted and confirmed there was missing two pills. FM suggested to count the refill bottle that he stated the facility has not touched since picking the prescription up from the pharmacy. The quantity on the label was 60. After counting three times, it was a total of 61 pills. FM asked if he can put the extra pill in the bottle that was missing two, LPA advised both FM and ADM to keep all medication in their assigned bottle and to consult with the pharmacy regarding the quantity in both pill bottles. C2 and C3 bottles contained the correct quantity of pills. ----------Cont on 809-c--------- LPA conducted exit interview with Mark Pons, Facility Manager at 1: PM. LPA provided the Summary Report to Juvy Golub, Licensee upon completion. One deficiency was observed (refer to LIC 809D) and cited from the California Code of Regulations, Title 22, and Health & Safety Codes during the inspection.

met_with: Mark Pons and Juvy Golub


facility_name: HAYNES FAMILY OF PROGRAMS

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis conducted a virtual Component II session via Microsoft Teams with Haynes Family of Programs on February 07, 2023 at 2:00pm. Present at the Component II from Haynes Family of Programs were Douglas Yost, Vice President Therapeutic Programs and Michael MIller, Senior Director of Residential Programs. During the meeting the following items were discussed: 1. Staff Associations 2. Group Home Program Statement revisions 3. LIC 309 4. Emergency Intervention Plan 5. LIC 200 6. Fire Inspection 7. Neighborhood Complaint Policy 8. Client age ranges 9. LIC 500 10. Admission Policies 11. Medical/Dental 12. Chores LPA asked questions regarding the provider's Program Statement to assess their understanding of the regulations in place for a Group Home. LPA advised the provider that all revisions/corrections should be submitted directly to him for review. The Pre-Licensing inspection will take place on Thursday, September 16, 2023. LPA advised the provider that their program statement and all application materials will also be reviewed by his manager, LPM Yan Yeung. Exit Interview conducted


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on February 16, 2023 at 9:20am for the purposes of an announced Pre-licensing inspection. The Department has received application materials from the facility to become licensed as a group home licensee at the site. LPA Davis met with Michael MIller, Senior Director of Residential Programs and Brian Tungate, Sr. Director of Operations, and together they toured the facility inside and outside. The facility is located in a residential neighborhood and is seeking to be licensed to provide care to twelve males ages 7-17 years old. The clients will be housed in Gatchell Cottage. There are six bedrooms in the cottage and each room has two twin beds, desk, and closet space. There are telephones available for the clients to use. Sharp knives, medications and cleaning supplies are kept locked in areas inaccessible to children. Overall, the facility appeared clean, safe, and sanitary. LPA observed fully charged fire extinguishers throughout the facility. Exit signs were also visible throughout the facility as well. The outdoor areas were observed to be free of debris and hazards. LPA observed the kitchen area to be clean and the refrigerators were well stocked with ample food supply. LPA also observed adequate perishable and nonperishable food items at the facility. There is a properly secured in-ground swimming pool on the premises enclosed with a self-latching gate. LPA also toured the cafeteria, nurse's station, therapy area, and the on grounds gymnasium. The facility has several indoor and outdoor activities on the premises for the clients. The facility has locked file cabinets for the client files. Smoke alarms were operable throughout the facility. There is adequate space outdoors for the clients to use. LPA spoke with the facility's nurse and inquired about their policies and procedures regarding potential client injuries and incident reports. There is adequate seating in the dining area and the living room. All exits were free of hazards and all doors opened freely. LPA observed six passenger vehicles designated for the residents. LPA was provided with copies of the minutes from the Board of Director's most recent meeting that was held on September 29, 2022. LPA found no Title 22 deficiencies on this date. Exit interview conducted LPA Davis discussed cold weather conditions and precautions with the provider and provided them with the Department's website address (www.ccld.ca.gov). LPA also conducted a Component III at the facility with Michael MIller, Senior Director of Residential Programs. During the Component III meeting, the following forms were given and/or discussed: LIC Preplacement of Appraisal Information LIC Appraisal/Needs and Services Plan LIC Physician's Report for Community Care Facilities LIC Identification and Emergency Information LIC Personal Rights LIC Record of Client's Safeguarded Cash Resources LIC Consent for Emergency Medical Treatment LIC Centrally Stored Medication and Destruction Record LIC Client/Resident Personal Property and Valuables LIC Unusual Incident/Injury Report LIC Admission Agreement Guide The provider was also briefed about community passes, room searches/strip searches, community sensitivity, and client education. LPA Joe Martinez observed the Pre-licensing inspection and the Component III.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on November 02, 2023 at 12:56pm for the purposes of a Post Licensing inspection. LPA met with Douglas Yost, Vice President of Therapeutic Programs (VPTP), and discussed the nature of today's inspection. The group home is located in a residential neighborhood and currently has five youth in placement. LPA and VPTP toured the facility inside and outside. During the inspection, LPA observed six bedrooms in the residential cottage and each room has twin beds, desks, and closet space. Sharp knives, medications and cleaning supplies are kept locked in areas inaccessible to children. Overall, the facility appeared clean, safe, and sanitary. LPA observed the bathrooms to be in good repair and working order. A menu was posted that itemized the necessary items for dining purposes. There is adequate space in the living room area. LPA observed a game room for the clients' use. LPA observed fully charged fire extinguishers and exit signs inside the facility. LPA also observed a fully stocked linen closed and a laundry room. There is a properly secured in-ground swimming pool on the premises enclosed with a self-latching gate. VPTP stated that there weren't any firearms or other weapons on the premises. The facility currently has five vans and one sedan for client transportation needs. The last fire drill was conducted at two separate times on January 25, 2023 at 7:30am and 5:10pm, respectively. LPA observed the following posted on a bulletin board: personal rights information, emergency disaster plan, evacuation plan information, and the facility license. Smoke alarms were operable throughout the facility. There is adequate space for indoor and outdoor activities. The outdoor areas were observed to be free of debris and hazards. LPA reviewed staff and client files and found the reviewed files to be in order. The most recent Board of Director's meeting occurred on September 28, 2023. LPA obtained an updated LIC500 (Personnel Report) and a client roster. LPA found no Title 22/ILS deficiencies on this date. Exit interview done


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on March 21, 2024 at 11:45am for the purposes of a Random Annual inspection. LPA met with Michael Miller, Sr. Vice President, Jazmin Roybal, Quality Assurance Coordinator, and Nicolas Galarza, Residential Unit Manager and toured the facility. The group home is located in a residential neighborhood and currently has four youth in placement. During the inspection, LPA observed six bedrooms in the residential cottage. Each bedroom has twin beds, desks, and closet space. Sharp knives, medications and cleaning supplies are kept locked in areas inaccessible to children. LPA observed fully charged fire extinguishers inside the facility. Overall, the facility appeared clean, safe, and well maintained. Smoke alarms were operable throughout the facility. Exit signs were visible as well inside the facility. LPA observed two resident bathrooms in good repair and working order. A menu was posted that itemized the necessary items for dining purposes. There is adequate space in the living room area. The kitchen was clean and had a fully stocked refrigerator. LPA observed the facility license, personal rights information, Emergency Disaster Plan, facility sketch, and the Evacuation Plan posted on a bulletin board. LPA observed a game room for the clients' use. LPA also observed a fully stocked linen closet that also contained individual toiletry items for each resident. The facility has four vans and one automobile for client transportation needs. LPA observed a secured in-ground swimming pool on the premises enclosed with a self-latching gate. The last fire drill, evacuation drill, and earthquake drill occurred on March 14, 2024 at 10:30pm. The Sr. Vice President stated that there weren't any firearms or other weapons on the premises. LPA obtained a copy of the minutes relating to the most recent Board of Director's meeting that was held on January 25, 2024. LPA reviewed client and staff files and found the reviewed files to be in order. LPA also obtained an updated LIC500 (Personnel Report) and a client roster. LPA found no Title 22/ILS deficiencies on this date. Exit interview done


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs for the purposes of finalizing the follow up on a Special Incident Report (SIR) that was received by Community Care Licensing (CCL) on July 22, 2024. LPA met with Jazmin Roybal, Quality Assurance Coordinator, and discussed the matter. The incident report stated that client #1 (see Confidential Names form (LIC 811) dated September 27, 2024) reported to his mother during a telephone call at the facility that he was inappropriately touched by another client (LIC 811) at the facility. Information obtained shows that the two clients were in the swimming pool at the facility when the incident allegedly took place. The investigation revealed that staff was available and was providing supervision, but did not witness any inappropriateness. Client #1 contacted his mother about the matter on July 20, 2024. The client's mother came to the facility on July 20, 2024 and decided that she would remove client #1 from the facility. Client #2 indicated that the two clients had been horse-playing in the pool. Information gathered also shows that staff spoke with client #2 and reminded him of personal boundaries and respecting his peers. Information gathered shows that client#1 informed his mother upon returning home that the incident never happened. Based on information and facts obtained in this matter, the Department finds that the clients were in the swimming pool under staff supervision. Client #1 has denied the allegations. His mother has removed him from the facility. The Department is unable to find any evidence of the allegations occurring. Nevertheless, the situation has been stabilized and no further follow up is needed. Exit interview done