summary: Facility Evaluation

raw_content:
Narrative:
On April 7, 2026 at approximately 10: AM, Licensing Program Analysts (LPA) Zaria Turner, made an unannounced visit to the above Temporary Shelter Care Facility (TSCF) facility, for the purpose of conducting a post licensing inspection. LPA met with Karla Garcia Maldonado, Social Worker, and walk through of the interior and exterior of the facility was conducted. LPA conducted a walk though of the interior and exterior of the facility. LPA observed the posting of License, Personal Rights, and Emergency Disaster Plan. The facility consists of 3 bedrooms, 2 bathrooms, living room, kitchen, dining room, lounge room, staff office, and garage. Each client room is equipped with 2 twin size beds, bedding, 2 bedside tables, and closet space for clothing and personal belongings. The youth and staff bathrooms at the facility are equipped with working toilets, shower/tub, and running water. Upon entry, there is a desk and monitor, 2 sofas, side table, a TV, and a coffee table. The dining room is equipped with a table, 3 chairs, a bench, a bookshelf, and lockers where personal youth belongings are kept. The lounge room is equipped with 1 sofas, 2 chairs, 1 monitor, and a TV. The staff office is equipped with 2 desks, 3 monitors, 4 chairs, a staff and client filing cabinet, and a staff fridge. The garage is converted into a storage room equipped with extra toiletries, cleaning supplies, dining utensils, racks used to store nonperishable foods, a fridge and freezer to store perishable foods. There is a washer and dryer located in the garage and cabinets above where extra linen, toiletries, and cleaning supplies are kept and locked away. Medication is centrally stored, locked, and inaccessible to clients in care. Disinfectants/cleaning solutions are inaccessible to clients in care and locked, in the office closet and above the laundry units. Continue summary of inspection on 809-C The refrigerator temperature is at or below 45 degrees F. There is nonperishable food for one week and fresh perishable food for three days minimum. There are containers to place leftover food. Carbon monoxide and smoke detectors are in working order. Temperature in facility is between 68 degrees F and a maximum of 85 degrees F. Hot Water between 105-120 degrees F. Fire Extinguishers are up to date and in working order. The toilets, bathtubs, and shower fixtures are in good repair. Soap and paper towels are available to clients in care. There is a working telephone accessible to clients. The facility is free of vermin. The backyard contains a covered patio area with 2 sofas, 3 chairs, and a picnic table. There is a grassy area with a picnic table. There is no pool on the premises. A Technical Violation (TV) was assessed during today's inspection. (See LIC TV) An exit interview was conducted with Social Worker, Karla Garcia Maldonado, and a copy of this report was discussed and provided during today's inspection.

met_with: Karla Garcia Maldonado, Social Worker


state: CA

facility_name: SACRAMENTO WELCOME HOME (SWH)-MARIPOSA HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On April 7, 2026 at approximately 10: AM, Licensing Program Analyst (LPA) Zaria Turner, made an unannounced visit to the above Temporary Shelter Care Facility (TSCF) to follow up on an incident report received by the department on January 30, 2026, involving telephone policy. LPA met with Social Worker, Karla Garcia Maldonado. LPA conducted a walk though of the interior and exterior of the facility. LPA Turner conducted three staff interviews. This case management is closed, no further investigation is needed. An exit interview conducted and a copy of this report was left with Karla Garcia Maldonado, Social Worker.

report_type: Facility Evaluation

visit_type: Case Management


facility_name: COUNTY OF SACRAMENTO DCFAS SUNSET HOUSE

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on observations and interviews, the preponderance of evidence standard has been met; therefore, the allegation that Unlicensed care is being provided is Substantiated. An exit interview was conducted, the Appeal Rights were discussed, and a copy of this report is being provided to Program Manager Carrillo.

Investigation Findings:
13On 05/03/2024 at 3: PM Licensing Program Analyst (LPA) Chad Cabigon met with Veronica Carrillo, Program Manager at the Branch Center Rd. County of Sacramento offices, the purpose of which was to deliver the findings of this complaint investigation. On 04/04/2024 the Community Care Licensing Division (CCLD) of the California Department of Social Services (CDSS) received a complaint alleging unlicensed care was being provided in a house located at the address indicated on the top portion of this report. On 04/08/ LPA Chad Cabigon conducted an onsite inspection at the aforementioned location and met with County of Sacramento Division Manager Cathi Johnson. LPA was given a tour of the interior and exterior areas of the physical plant; LPA observed that there was one youth on premises-an interview was conducted with said youth. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: COUNTY OF SACRAMENTO DCFAS SUNSET HOUSEFACILITY NUMBER: VISIT DATE: 05/03/2024

report_type: Complaint Investigation

met_with: Veronica Carrillo

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The Department investigated the allegation, "Staff are not properly trained." Two of five staff members interviewed stated they were behind on training. One staff stated they did not receive initial training upon hire. Record review of staff training log and program statement indicates that 10 of 11 staff have not received initial 90 day required training. Five of the staff have not completed Mandatory Reporting training. Six staff have not completed the De-escalation training. Therefore, the evidence supports that this allegation is substantiated. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5 , Personnel Requirements (i)(3) are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to facility staff, Name, TITLE. The Department investigated the allegation. "Staff are denying minors mental health treatment." Two of two clients interviewed stated mental health services have been offered to them. Five of five staff corroborate that outside vendors come into the facility to offer support services to the clients in care and mental health services are offered to the youth during their initial Child and Family Team meetings. Therefore, it is not possible to determine whether the allegations occurred or not. Based on the investigation, the records reviewed, and the interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. In regard to the allegation, staff are not providing a safe environment for minors in care, both clients interviewed stated they feel safe in the facility. One client stated that staff help when kids are yelling by talking to them. Regarding the arrest alleged by the reporting party, upon review, this did not occur at this location. A supervisor of the facility stated there have been no arrests of clients for altercations between clients. And record review of incident reports supports this statement. Five of five staff corroborate the facility is safe. Statements by staff include "we engage with youth to keep them safe", "we set up the environment to be safe", "we keep others safe by directing them away from escalated youth", and "safety checks are conducted every thirty minutes." Therefore, it is not possible to determine whether the allegation occurred or not. Based on the investigation, the records reviewed and the interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to facility staff Danielle Chan Supervisor.

Investigation Findings:
13Licensing Program Analysts (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 11/21/2024 at 1: PM. LPA Goldie spoke with Danielle Chan Supervisor to discuss the findings of the complaint investigation and allegations stated above. The initial 10-day complaint investigation inspection was conducted by LPAs Connie Goldie and Tina Thorn at the facility on 09/03/2024. LPAs conducted a Health and Safety inspection which was led by staff, Ka Xiong, Engagement Social Worker (ESW). LPAs conducted one staff interview with La Shon Tate, Supervisor. During the course of the investigation LPA conducted 4 additional staff interviews and two client interviews and reviewed the following records placement roster, staff training log, and serious incident reports. Two clients declined to be interviewed. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - CHICAGO HOUSEFACILITY NUMBER: VISIT DATE: 11/21/2024

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: Danielle Chan Supervisor Esteban Baul Engagement Social Worker-Facility Manager

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
The Department investigated the allegation, "Facility operating outside of the scope of their license." During the physical plant inspection, LPA observed a Fisher Price toy set up in the living room on an end table with bins of pre-school toys underneath. Staff stated the facility is now an all age, all gender home-0-18 years as it has become the intake house. The facility is licensed provisionally to provide temporary shelter care services up to 10 day to children 6-17 years old. Record review of census indicates on 11/22/2024, 12/02/2024 and 12/03/2024 children under six were placed in care at the shelter. (C2, age 4 months, C3 age 1 year, C4 age 3 years and C5 age 3 years) Therefore, the evidence supports that this allegation is substantiated. Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, Article 2 , 80010(a) Limitations on Capacity and Ambulatory Status are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 12/18/2024 at 10: AM. LPA Goldie spoke with Ka Xiong, Facility Manager to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was conducted by LPA Goldie at the facility on 12/03/2024. LPA conducted a Health and Safety inspection which was led by staff, Guillermo Torres, Engagement Social Worker (ESW). LPA conducted one staff and one client interview. LPA reviewed census documentation for 11/17/2024 through10: AM 12/03/2024 and facility provisional license. Continued on LIC9099C. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - CHICAGO HOUSEFACILITY NUMBER: VISIT DATE: 12/18/2024

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

met_with: Ka Xiong, Facility Manager


raw_content:
Narrative:
The Department investigated the allegation, "Facility is in disrepair." During the physical plant inspection conducted on 10/24/2025, LPA observed a broken cabinet above washer and dryer which S1 stated had been broken since August 2024. LPA observed garage door exit to the backyard to have two pieces of plywood hammered on the outside making the door inaccessible. S1 stated the plywood was applied on 10/19/2024 by facility maintenance and it was estimated to be replaced in 2-3 weeks. Additionally, cloth storage space drawers for clients were visibly soiled in bedrooms #1 and #2. During a subsequent visit on 12/18/2024, LPA observed that garage exit door was still not repaired, and plywood pieces were still present. Therefore, this allegation is substantiated. Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, Article 7, 80087(a) Buildings and Grounds are being cited on the attached LIC 9099D. Regarding the allegation, "Staff are not safeguarding residents' belongings", a youth, C3, stated their belongings were placed outside including a laptop, clothing, two backpacks and brushes, due to head lice and were unable to be accessed for a week or two. Three staff corroborated that these belongings were placed outside for this reason. A laptop requires being secured to be safeguarded. Record review of program statement indicates that belongings not in youth's possession are stored in the garage. Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, Article 3 Safeguards for Cash Resources, Personal Property and Valuables of Residents are being cited on the attached LIC 9099D. An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility. Regarding the allegation, "A youth displayed inappropriate sexual behavior in front of another youth", two clients declined to be interviewed. Six of six staff interviewed stated they were unaware of any youth masturbating in front of another youth in the home. Therefore, due to clients' refusal to be interviewed, it is not possible to determine whether the allegation occurred or not. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Chad Cabigon arrived at the agency to conduct an unannounced complaint investigation inspection on 02/06/2025 at 4: PM. LPA Cabigon spoke with Danielle Chan, Engagement Social Work Supervisor, to discuss the findings of the complaint investigation and allegations stated above. LPA Connie Goldie conducted this investigation. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 10/24/2024. LPA conducted a Health and Safety inspection and conducted four staff interviews. LPA completed a record review of work requests submitted to facility managers, program statement and intake paperwork for C1, C2, C3 and C4. During the course of the investigation, six youth interviews and six staff interviews were completed. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - CHICAGO HOUSEFACILITY NUMBER: VISIT DATE: 02/06/2025

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

met_with: Danielle Chan


raw_content:
Narrative:
The Department investigated the allegation, "Youth in care are being restrained by untrained staff." Three of seven staff interviewed stated they have utilized "bear hugs" described as "open arms wrapped around a youth" and going underneath the arm of a youth and giving them a hug" when youth are unsafe. An additional staff disclosed that they have observed staff give youth "bear hugs" in the name of self-defense and another staff stated that "bear hugs" were taught in a self- defense class. Record review of training log did not indicate a self-defense course. A youth also disclosed witnessing a staff put hands on a youth forcefully to move them. Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 5, Article 8, Emergency Intervention Staff Training 84365(a) are being cited on the attached LIC 9099D." Administrator, Alicia Wasklewicz, provided the plan of correction via telephone for this citation. An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility. The Department investigated the allegation, "Reporting requirements are not being met." It was alleged that reporting requirements are not being met in relation to restraints not being documented and submitted to the department. Staff interviewed stated that they understand the procedure and that it is a mandatory part of their job to report any restraints that occur during the staff member's shift. Six out of seven interviews reported that all incidents of restraints had been documented and submitted timely to the department. LPA reviewed records and not all staff have completed the incident reporting training. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated." An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 04/07/2025 at 02: PM. LPA Goldie spoke with Esteban Baul, Facility Manager to discuss the findings of the complaint investigation and allegation stated above. LPA Connie Goldie conducted this investigation. The initial 10-day complaint investigation inspection was conducted by LPAs Connie Goldie and Tina Thorn at the facility on 01/14/2025. LPA Thorn conducted a Health and Safety inspection and conducted four staff interviews. LPA Goldie completed a record review of staff schedules and youth rosters for November and December 2024. During the course of the investigation, eleven confidential interviews were completed. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - CHICAGO HOUSEFACILITY NUMBER: VISIT DATE: 04/07/2025

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

met_with: Esteban Baul, Facility Manager


raw_content:
Narrative:
page LIC The Department investigated the allegation, "Staff did not provide adequate supervision to ensure safety of youth." All interviewed youth admitted to being exposed to vaping and/or marijuana use in the facility. There was also substantial corroboration through obtained statements that youth were exposed to, or possibly even recruited for, CSEC (Commercially Sexually Exploited Children) activities. Staff interviewed stated they communicate with youth about safety and making healthy choices and provide harm reduction strategies when youth are determined to participate in unsafe activities. Upon observation of drug use, staff attempt to confiscate contraband. There was not enough evidence to clearly and directly attribute these instances to a lack of supervision on the part of facility staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated." An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at shelter to conduct an unannounced complaint investigation inspection on 04/25/2025 at 03: PM. LPA Goldie spoke with Danielle Chan, Engagement Supervisor and Michael Gilbert, Facility Manager to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was conducted by LPA Chad Cabigon on 02/06/2025. At the shelter, LPA Cabigon obtained the following documentation: PMIs (Placement Matching Information), Youth Intake Screening Tools, Health & Education Passports, Daily Progress Logs, and a youth's Care & Goal Plan as well as a Safety Plan. During the investigation, eighteen confidential interviews were conducted between 02/06/2025 and 04/17/2025. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - CHICAGO HOUSEFACILITY NUMBER: VISIT DATE: 04/25/2025

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

met_with: Danielle Chan, Engagement Supervisor Michael Gilbert, Facility Manager


raw_content:
Narrative:
Regarding the allegation, "Staff did not ensure that the facility was free of pest in a timely manner," seven of nine confidential interviews stated that pest concerns were not initially handled efficiently. Record review of documentation indicates C1 and C2 were treated for bug bites on 01/01/2025 and 1/10/2025. After learning a potential bed bug exposure occurred on 01/02/2025, staff did look for evidence of bugs present but did not observe presence of pests. According to documentation, staff did not take preventative steps until 01/10/2025 after another child received bites. On 01/12/2025, Orkin Pest Control was contacted and observed the presence of bed bugs and beetles on 01/13/2025 and the youth were evacuated the same day to another location. The shelter was fumigated. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, 800879(a)(1) Buildings and Grounds are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility. The Department investigated the allegation, "Staff are providing unnecessary searches of minors." Five of nine confidential interviews stated inventory checks are requested but, youth can refuse to comply. Two of nine interviewed stated youth are not allowed inside until an inventory check is completed. Due to inconsistent statements made corroboration was unable to be reached. Regarding allegation "Staff did not safeguard belongings" it was alleged that a youth's belongings were placed outside in trash bags that were not fully closed, leaving them exposed to the elements and damp conditions. Confidential interviews did not corroborate that this occurred. One of six youth interviewed stated their stuff was put outside but, then taken by a staff to have professionally cleaned. Another stated that they didn't know what was done with their stuff and a third stated staff placed their belongings in a bag in the garage. One of five staff stated clothing was laundered professionally the day youth vacated the home so it could be treated. The Department investigated the allegation, "Facility's washer is in disrepair." Two of nine confidential interviews stated washing machine was broken In January. One interviewee stated it was broken for 2-3 weeks in January 2025. One stated they were unsure if washer was broken. It was stated that a laundering service picked up laundry while the washer was out of service once a week. It is unknown if a request was made for repair of the washing machine prior to 01/10/2025. Based on record review, the washing machine was reported to be broken on 01/10/2025 and a new one was ordered the same day and delivered to the facility on 01/14/2025. Although these allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated." An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 04/25/2025 at 04: PM. LPA Goldie spoke with Danielle Chan, Engagement Supervisor and Michael Gilbert, Facility Manager to discuss the findings of the complaint investigation and allegation stated above. LPA Connie Goldie conducted this investigation. The initial 10-day complaint investigation inspection was conducted by LPAs Connie Goldie and Tina Thorn at the facility on 01/14/2025. LPA Thorn conducted a Health and Safety inspection and conducted four staff interviews. LPA Goldie completed a record review of staff schedules and youth rosters for November and December 2024, and medical report for C1. During the course of the investigation, ten confidential interviews were completed. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - CHICAGO HOUSEFACILITY NUMBER: VISIT DATE: 04/25/2025

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


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview and appeal rights were discussed with Danielle Chan, Engagement Supervisor. A copy of this report along with the appeal rights were given to the facility.

Investigation Findings:
13On May 21, 2025, at 09: AM, Licensing Program Analyst (LPA) Michelle Silvas arrived at Sacramento Welcome Home - Chicago House, to deliver the findings of the allegations listed above. LPA met with Danielle Chan, Engagement Supervisor, who assisted with today's inspection. LPA conducted a walkthrough of the facility inside and out. 3 staff and 2 youth are present. LPA conducted the initial 10-day complaint investigation at the facility on February 12, 2025. LPA conducted nine confidential interviews between 2/12/25 - 5/5/25. It was alleged that a staff member has given a youth a "wedgie", made fun of a youth's confidential information and shared it with other youth in the home and has tried to initiate a fight with a youth. Eight out of nine confidential interviews stated that they have never seen a staff member give a wedgie to a youth in care. Nine out of nine confidential interviews stated that they have never observed a staff member try to initiate a fight with a youth in care. Eight out of nine confidential interview stated that they have not observed a staff member share a youth's confidential information with other youth in the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Michelle Silvas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - CHICAGO HOUSEFACILITY NUMBER: VISIT DATE: 05/21/2025

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

met_with: Danielle Chan, Engagement Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On May 7, 2026 at approximately (Time), Licensing Program Analyst (LPA) Zaria Turner, made an unannounced visit to the above facility for the purpose of conducting a Case Management to follow up on an incident report received by the department on April 30, 2026. LPA Turner met with Engagement Supervisor, Danielle Chan. A tour was conducted of the facility. LPA Turner observed the following deficiencies. · Overcapacity on April 30, 2026. This case management is closed, no further investigation is needed. An exit interview conducted and a copy of this report was left with Danielle Chan, Engagement Supervisor


raw_content:
Narrative:
LPA investigated an allegation that Staff spoke inappropriately to a minor. Interviewed County staff corroborated that a security officer, employed by a security agency contracted by the County of Sacramento, who was posted at this Sacramento Welcome Home location got into a heated verbal altercation with a youth after that youth threw activity material that hit the security staff. The verbal exchange was characterized by "a lot of cussing" and inappropriate statements made by the security officer to the youth including threats of violence. Based on LPA's interviews and a record review, the preponderance of evidence standard has been met; therefore, the allegation is found to be Substantiated. CCR Title 22, Division 6, Chapter 5, Article 06, Section 84072(d)(19) is being cited on the attached 9099-D. Exit interview conducted. A copy of this report, as well as the Appeal Rights, is being provided to the facility. would not have been directly observed by any non-County individual being that only the security officer and the youth in question were involved and no one else was present outside of the three residential staff who intervened when the verbal altercation took place-though there were other youth residents on the premises, those clients were in the bedroom(s). LPA found no indication that County residential staff did not intervene appropriately and in a timely manner-the youth and the security officer were separated and did not come to blows despite apparent posturing from both individuals. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. Exit interview conducted and a copy of this report, and of the Appeal Rights, is being provided to the facility.

Investigation Findings:
13On 01/16/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this TSCF (Temporary Shelter Care Facility) to close the complaint investigation. LPA met with Danielle Chan, Social Work Supervisor, to whom the following findings were delivered: LPA opened the complaint investigation on 09/26/2024 at the facility, during which time a tour of the interior and exterior areas of the Shelter's physical plant was conducted and the following records were requested for review: a client's intake documents, contact numbers for specific staff, and information pertaining to the security agency involved. LPA interviewed children, residential staff and additional County personnel, as well as youth advocates. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSEFACILITY NUMBER: VISIT DATE: 01/16/2025

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


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegations above have been substantiated. 4 out of 5 confidential interviews stated that the facility has been operating over capacity on and off during the month of October 2024, due to population fluctuations and the abundant need for this specific facility type. Also, during review of the client roster for October 2024 it was confirmed by the LPA that there was a 5-year-old child placed at the facility from 10/20/2024-10/24/2024, it was also confirmed by staff members that a minor under 6 was placed at the facility for that length of time. Also, during today's visit on January 17, LPA observed the facility to be over capacity by one. Based on LPAs observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Interim Licensing Standards are being cited on the attached LIC 9099D. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On January 17, 2025 at 10:50am Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit to deliver findings to the above Temporary Shelter Care Facility (TSCF) and met with Kaeley Vang, House Manager. Prior to the meeting LPA Shulz, conducted the 10-day inspection of the facility on 10/30/2024. No deficiencies were cited during that inspection. LPA Shulz requested, the staff roster, staff training hours, and the client roster for the month of October. LPA Shulz conducted 5 interviews between 10/30/2024-1/08/2025. Continue to LIC 9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tatyana Shulz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSEFACILITY NUMBER: VISIT DATE: 01/17/2025

met_with: Kaeley Vang- House Manager


raw_content:
Narrative:
The Department investigated the allegation, "Staff did not provide adequate supervision to ensure safety of youth." All interviewed youth admitted to being exposed to vaping and/or marijuana use in the facility. There was also substantial corroboration through obtained statements that youth were exposed to, or possibly even recruited for, CSEC (Commercially Sexually Exploited Children) activities. Staff interviewed stated they communicate with youth about safety and making healthy choices and provide harm reduction strategies when youth are determined to participate in unsafe activities. Upon observation of drug use, staff attempt to confiscate contraband and discourage the use. There was not enough evidence to clearly and directly attribute these instances to a lack of supervision on the part of facility staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Chad Cabigon arrived at shelter to conduct an unannounced complaint investigation inspection on 04/30/2025. LPA Cabigon spoke with Brittany Taylor, ESW, to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was initiated by LPA Chad Cabigon on 02/06/2025. At the shelter, LPA Cabigon obtained the following documentation: PMIs (Placement Matching Information), Youth Intake Screening Tools, Health & Education Passports, Daily Progress Logs, and a youth's Care & Goal Plan as well as a Safety Plan. During the investigation, 13 confidential interviews with youth and eight interviews with staff were conducted between 02/06/2025 and 04/17/2025. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSEFACILITY NUMBER: VISIT DATE: 04/30/2025

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

met_with: Brittany Taylor, ESW


raw_content:
Narrative:
Though actual rendering of services were inconsistent, interviewed youth indicated that mental health services are generally made available or facilitated by the Shelter as necessary; actual referrals are within the purview of the County's case-carrying placement or permanency Social Workers who are not part of the residential staff at the Shelter. No youth reported any instances of not being taken to acute care when medically necessary though there has been at least one instance where Shelter staff should have sought for services sooner on behalf of a minor. Regarding a possible mishandling of medication administration, though LPA was not able to independently verify that a youth was taken to emergent or acute care, there was sufficient corroboration between the interviewees that this was done, and that this was done to have the youth evaluated following staff deciding to hold a psychotropic medication. The medication being whithheld was due to concerns about adverse drug interactions as the youth was suspected of being under the influence of an illicit substance at the time. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are Unsubstantiated. Exit interview conducted; a copy of this report and of the Appeal Rights are being provided to the facility.

Investigation Findings:
13On 04/30/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this TSCF (Temporary Shelter Care Facility) to deliver the findings of, and close, the complaint investigation. LPA met with Brittany Taylor, ESW, to whom the following report was delivered: UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSEFACILITY NUMBER: VISIT DATE: 04/30/2025

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


raw_content:
Narrative:
Sacramento Welcome Home (SWH) confirmed the use of a cot for the youth client to sleep in during at least that one night in question, and that the cot was situated in a play or activity area adjacent to the Shelter's kitchen. LPA was shown the cot and the beddings usually provided for youth clients when this sleeping arrangement is necessitated--though the cot was found to be in good working order, the use of cots are prohibited. Furthermore, the aforementioned open space in which the cot was situated cannot be used as a bedroom for clients. Based on LPA's observations and interviews, the preponderance of evidence standard has been met; therefore, the allegations are found to be Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 5, Article 07, Sections 84087(b)(4) and 84088(c)(1)(C) are being cited on the attached 9099-D. Exit interview conducted; this report and the Appeal Rights are being provided to the facility

Investigation Findings:
13On 10/09/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this TSCF (Temporary Shelter Care Facility) to deliver the findings of, and close, the complaint investigation. LPA met with Brian Golson, Engagement Social Worker, and Danielle Chan, Social Work Supervisor, and the following report was discussed: Community Care Licensing (CCL) investigated a complaint allegation that "Client not provided appropriate bedroom accomodations." The investigation was initiated on 07/11/2025 during which time a tour of the interior and exterior areas of the facility's physical plant was done with focus on the Shelter's provisions for bedroom and/or sleeping accommodations. Interviews were conducted with Sacramento Welcome Home direct-care staff; none of the clients on the premises agreed to be interviewed at that time. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSEFACILITY NUMBER: VISIT DATE: 10/09/2025

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

met_with: Brian Golson, Engagement Social Worker


facility_name: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 03/13/ Licensing Program Analysts (LPA) Tatyana Shulz and Chad Cabigon met with (NAME) in the County of Sacramento office at Branch Center Rd., Sacramento, CA 95827. The following report was delivered: Community Care Licensing (CCL) confirms the receipt of application documents for the Pasadena facility submitted in person by Division Manager Cathi Johnson on 03/06/2024. Those documents were the following: LIC 200, LIC 309, LIC 400, LIC 610C, and LIC 9054. The following forms/elements of the application are either in need of more information or have yet to be submitted: -on the LIC 610C: additional, local agency-specific names and contact numbers are needed for the fields where "911" was inputted. -LIC 215 (Applicant Information) -LIC 308 (Designation of Facility Responsibility) -LIC 500 (Personnel Report) -LIC 501 (Personnel Record -LIC 508 (Criminal Record Statement & Out-Of-State Disclosure) -LIC 999 (Facility Sketch) -Sections in the Program Statement (B docs) that need to be revised to include the new facility. Ms. Carrillo is advised that these documents are due on 03/22/2024. Ms. Carrillo was advised that the submission of the facility sketch, in particular, was time-sensitive because it is a requirement to obtain the fire clearance.

met_with: Veronica Carrillo, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 04/09/ Licensing Program Analyst (LPA) Chad Cabigon conducted a Prelicensing Inspection at this location as part of the licensure process for a Temporary Shelter Care Facility (TSCF). LPA met with County of Sacramento Division Manager Cathi Johnson. LPA was given a tour of the interior and exterior areas of the facility's physical plant. The facility has two client bedrooms with each room having two beds; the bedrooms contained the required bedding observed to be in good condition; there is one common or shared full bathroom for the children's use situated between the bedrooms--the bathroom was in good repair, hygienic products were observed to be on hand, and the fixtures provided hot water. The temperature in spaces/rooms that clients occupy was within the required range. There are multiple refrigerators and/or freezer units all observed to be in good working condition and provided temperatures within the required range for perishable items. There is also sufficient storage space for dried goods or non-perishable items. The facility currently has a sufficient amount of perishable and non-perishable food items for at least three days and one week, respectively. Also observed within a secured staff office were lockable cabinets for confidential files and medications and a first aid kit which contained the required items. Potentially hazardous cleaning agents and chemicals were stored appropriately in the laundry area which was securable. The backyard was found to not have any potentially hazardous areas or items; the pathways were unobstructed. There is a detached covered garage on the property which was being used as additional storage for overstock groceries and other miscellaneous items. Ms. Johnson was advised of the following, as conditions of licensure: that not more than two children shall share a bedroom; children of different sexes shall not share a bedroom; no bedroom shall be used as a public or general passageway to another room, bath, or toilet (the larger space adjacent to the dining area and the staff office will have to be utilized to get to the staff office--there is no alternative entrance to the staff office); the use of cots or bunk beds shall be prohibited; sufficient personal storage space in the bedrooms shall be provided (a minimum of two drawers or eight cubic feet of drawer space is required for each child). A copy of this report is being provided to Ms. Johnson.

visit_type: Prelicensing

met_with: Division Manager Cathi Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On 05/01/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this pending TSCF (Temporary Shelter Care Facility) in response to reported operational concerns. LPA met with Brittany Taylor and Nykesha Sinegal-Thompson, Engagement Social Workers, who facilitated a tour of the physical plant; Ms. Sinegal-Thompson also facilitated an LPA interview with one youth; LPA inspected the House's stock of food items. Further inspection may be required; a copy of this report is being provided to the County of Sacramento.

met_with: Nykesha Sinegal-Thompson, ESW; Brittany Taylor, ESW


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on observations and interviews, the preponderance of evidence standard has been met; therefore, the allegation that Unlicensed care is being provided is Substantiated. An exit interview was conducted, the Appeal Rights were discussed, and a copy of this report is being provided to Program Manager Carrillo.

Investigation Findings:
13On 05/03/2024 at 4: PM Licensing Program Analyst (LPA) Chad Cabigon met with Veronica Carrillo, Program Manager at the Branch Center Rd. County of Sacramento offices, the purpose of which was to deliver the findings of this complaint investigation. On 04/04/2024 the Community Care Licensing Division (CCLD) of the California Department of Social Services (CDSS) received a complaint alleging unlicensed care was being provided in a house located at the address indicated on the top portion of this report. On 04/08/ LPA Chad Cabigon conducted an onsite inspection at the aforementioned location and met with County of Sacramento Division Manager Cathi Johnson. LPA was given a tour of the interior and exterior areas of the physical plant; LPA observed two youth on premises-one youth was interviewed at length. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME CENTER (SWC)-HILLTOP HOUSEFACILITY NUMBER: VISIT DATE: 05/03/2024


facility_name: SACRAMENTO WELCOME CENTER (SWC)-HILLTOP HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Statements from interviews, and records reviewed by LPA Thorn provided consistent information that staff were not providing a safe environment for minors in care and that staff were not properly trained. Videos obtained show staff yelling at minors and minors engaged in physical altercations while staff did not intervene, which created an unsafe environment for the minors in care. Staff training logs show that ten of eleven staff were missing mandatory reporting training and that only three of eleven staff completed de-escalation training. There was no evidence that the eleven staff working at this facility completed Trauma Informed Training or the required number of training hours outlined in the facility's Program Statement. Three staff corroborated that more training is necessary for them to feel as though they are prepared to meet the needs of the minors in care and reduce the numerous incidents at the facility, including multiple unauthorized absences, drug use inside the facility, and physical aggression between peers, which were reported to the Department. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5 , Personnel Requirements (i)(3) are being cited on the attached LIC 9099D." A signed copy of this LIC-9099 report, the LIC-9099C, and LIC-9099D were provided to the facility. An exit interview was conducted Appeal rights were provided. The allegation is that staff are denying minors mental health treatment. All staff interviews indicated that services are requested for minors immediately during minor's intake. All staff and Program Supervisors reported that sometimes there are issues that arise around county social workers who do not authorize or approve services timely, however, the services are never denied for any reason by the facility staff. Staff stated that minors sometimes refuse services. LPA reviewed records of the only three youth who were present at time of the inspection, who had been there for over 24 hours. All youth had names of their placement county social worker and the date that facility requested services and a CFT. All minors declined to be interviewed by LPA, however, during two visits to the facility, LPA observed at least one service provider arrive to work with a youth, and during one visit a staff was seen to be counseling a minor who was having trouble handling conflict. Based on LPA's observations, interviews which were conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report, the LIC-9099C, and appeal rights were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at the new location, as the facility has relocated since the complaint was opened. The purpose of the visit is to deliver findings for the complaint investigation. LPA Thorn spoke with Danielle Chan,Program Supervisor and Kaeley Vang, Engagement Social Worker. LPA Thorn conducted the complaint investigation. LPAs Tina Thorn and Connie Goldie opened the investigation with the facility on 09.03.24 and met with Esteban Baul, Engagement Social Worker, and conducted a Health and Safety Inspection. During the course of the investigation, LPA Thorn interviewed three staff members and the Reporting Party. LPA Thorn reviewed records including Placement Roster, interviews conducted by LPA Goldie, Serious Incident Reports, 4 videos, and training logs for staff. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Tina Thorn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME(SWH) - HILLTOP HOUSEFACILITY NUMBER: VISIT DATE: 11/21/2024

met_with: Danielle Chan, Program Supervisor Via phone, and Kaeley Vang, Engaagement Social Worker at facility.


raw_content:
Narrative:
All staff interviewed reported that the policy is for the youth's personal belongings to be packed up the day the youth left. The youth's belongings were inventoried at the time of admission. Per the records, the youth did not add items to their inventory after the admission date. There were inconsistent statements in interviews regarding what items the youth was missing. Records indicate the youth either never agreed to inventory all their items or did not have them in their possession upon admission into the program, releasing liability from the facility. Based on LPA's observations, interviews which were conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report, the LIC-9099C, and appeal rights were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at the Madison facility on 01.10.25 for the purpose of delivering findings for the complaint investigation. LPA met with Ka Xiong, Engagement Social Worker and Danielle Chan, Program Supervisor, on speaker by phone. LPA Thorn conducted the complaint investigation. LPA initiated the investigation with the facility on 10.21.24 and met with Sandra Gomez, Program Supervisor and conducted a Health and Safety Inspection. During the course of the investigation, LPA interviewed three county social workers, the reporting party, one youth, and five staff. LPA reviewed records including prior complaint history, Serious Incident Reports, Inventory logs, admission agreement handbook, and staff training log. All staff and Program Supervisors reported that any items belonging to the youth would have been packed up on the day the youth was detained and that they had no knowledge of the youth having the items that are listed as missing. In one reported incident, one youth left the facility and not all their belongings were accounted for. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Tina Thorn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME(SWH) - HILLTOP HOUSEFACILITY NUMBER: VISIT DATE: 01/10/2025


summary: Facility Evaluation

raw_content:
Narrative:
On 04/08/ Licensing Program Analyst (LPA) Chad Cabigon conducted a Prelicensing Inspection at this location as part of the licensure process for a Temporary Shelter Care Facility (TSCF). LPA met with County of Sacramento Division Manager Cathi Johnson. LPA was given a tour of the interior and exterior areas of the facility's physical plant. The facility has three client bedrooms with each room having two beds; the bedrooms contained the required bedding and furniture which were observed to be in good repair; most of the rooms had sufficient storage/drawer space for clients' personal belongings. There is one common or shared full bathroom in the hallway that leads to the bedrooms. There was a carbon monoxide detector observed in the hallway. All the bathrooms were generally in good repair, with toilets that flushed and fixtures that provided hot water. The temperature in spaces/rooms that clients occupy was within the required range. There are multiple refrigerators and/or freezer units all observed to be in good working condition and provided temperatures within the required range for perishable items. There is also sufficient storage space for dried goods or non-perishable items. The facility currently has a sufficient amount of perishable and non-perishable food items for at least three days and one week, respectively. Also observed within a secured staff office were lockable cabinets for confidential files and medications. Most of the potentially hazardous cleaning agents and chemicals were stored appropriately in a secured cabinet. The backyard was found to not have any potentially hazardous areas or items; the pathways are unobstructed. The following items will need to be addressed for the issuance of the provisional license: all cleaning agents/chemicals are to be secured; a weekly food menu is to be posted; the hallway bathroom's shower fixture (valve) is to be repaired; a separate log is to be kept for each psychotropic medication; a part of the east fence-line in the backyard is to be repaired (loose planks, exposed nails); personal storage space in the bedrooms shall be provided (a minimum of two drawers or eight cubic feet of drawer space is required for each child); curtain rods in the bedrooms are to be repaired/secured. A copy of this report is being provided to Ms. Johnson.

met_with: Cathi Johnson, Division Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 04/26/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this pending TSCF (Temporary Shelter Care Facility) in response to operational concerns reported to Community Care Licensing. LPA met with Liz Jones, Engagement Social Worker (ESW), who facilitated a tour of the physical plant. LPA discussed with ESW Jones what rooms or spaces may be used by youth for meetings (CFTs, intakes, etc.) or other purposes that require privacy (therapy services, etc.). Also inspected was the selection of food that the facility had on-hand for clients. Further inspection may be required at a later time. A copy of this report is being provided to the County of Sacramento.

met_with: Liz Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 05/01/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced case management inspection of this pending TSCF (Temporary Shelter Care Facility) in response to a recently reported unusual incident entailing events that occurred starting on 04/19/2024 and into 04/20/2024. LPA interviewed Engagement Social Worker Rashenda Williams and two youth. Further inspection may be required.

met_with: Engagement Social Worker


summary: Facility Evaluation

raw_content:
Narrative:
On 05/24/ Licensing Program Analyst (LPA) Chad Cabigon conducted a second prelicensing inspection of this facility and was met by Division Manager Cathi Johnson and Admin. Services Officer Hazel Magett. A tour of the facility was conducted with focus on items/areas that needed to be addressed during the last prelicensing inspection, namely: 1) the clients, for their bedrooms, have been provided with roll-out under-the-bed plastic bins for additional storage, 2) the hallway bathroom shower fixture has been repaired, 3) part of the east fence that was in disrepair has been fixed, and, 4) there now is new furniture and a new configuration in the common/living room area that adds dining space. Curtain rods in two of the client bedrooms need to be more properly secured. No other deficiencies were observed during this inspection. A copy of this report is being provided to the County of Sacramento.

met_with: Cathi Johnson, Hazel Magett


summary: Facility Evaluation

raw_content:
Narrative:
On 06/13/2024 a virtual meeting was held on the Microsoft Teams platform between CCL's Sacramento Children's Residential Program and Sacramento County CPS; the attendees were Licensing Program Analysts (LPA) Tina Thorn, Uchenna Ajaero, and Chad Cabigon, Licensing Program Managers (LPM) Jodean Hall, Rosa Rodriguez, and Hillary Hall, and Regional Manager Margo Castaneda on behalf of the State, and for the County, Division Manager Cathi Johnson and Program Planner Ali Neira. The purpose of the meeting was to formally introduce the assigned LPAs and LPMs for the various locations of the County's Temporary Shelter Care Facilities (TSCF). Those assignments are as follows: -LPA Thorn and LPM H. Hall for Hilltop House -LPA Ajaero and LPM J. Hall for Chicago House -LPA Cabigon and LPM Rodriguez for Pasadena House Also discussed was the Care for Children Under the Age of Six Years. The understanding is that Progress Ranch Treatment Service's TSCF will be the program contracted by Sacramento County to accept children under six years of age pending CCL's approval of Progress Ranch's update to its Plan of Operation. Progress Ranch has submitted preliminary records/supporting documentation requested by CCL which are currently under review. The County stated that talks are ongoing with Foster Family Agencies regarding the allocation of emergency placement beds in Resource Family Homes to help address placement overflow and ensure the TSCF's compliance with capacity limitations. In addition, Regulations pertaining to incident reporting were reviewed by way of a reminder that, apart from the 24-hour notification requirement, a full written report should be submitted within seven days of the reportable special or unusual incident.

met_with: Cathi Johnson, Ali Neira


facility_name: SAN MATEO COUNTY RECEIVING HOME TSCF

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia scheduled a Technical Assistance (TA) meeting at the request of the applicant, San Mateo County. Attendees to the meeting were: Nelson Martinez, Isabel Diego, Monica Pavia, Marjana Jackson, Alicia Bernstein, Gina Jones, Shamika Payne, Hong Luu, John Fong, Natasha Bourbonnais, Aimee Salazar-Nunez, and Samantha Johnston. Items discussed: 1. Plan of Operation to be formatted according to the Temporary Shelter Care Facility (TSCF) review tool and the TSCF Interim Licensing Standards 2. Plan for keeping STRTP and TSCF population separate 3. Attachments submitted referenced accurately The goal is to resubmit the Plan of Operation by Friday, February 24, 2023.

met_with: Aimee Salazar-Nunez


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2024, at 8:00am, Licensing Program Analyst (LPA) Monica Pavia conducted a pre-licensing inspection. San Mateo County Receiving Home submitted an application for a Temporary Shelter Care Facility (TSCF) license for a capacity of 6 ambulatory children, ages 6 - 17. This inspection was conducted with Administrator, Aimee Salazar-Nunez, and included observation of the following: The facility is a one story building, which includes several dayrooms and offices and open spaces for play/activities; the facility and grounds are in good repair, and free of obstructions; chemicals are stored and locked; locked and centrally stored medication cabinet observed; observed medication logs and discussed procedures for psychotropic medications; first aid kit complete; individual beds are in good repair; individual beds were observed with clean linens; additional bedding and linens observed; dayrooms are accommodating of all required furnishings; food storage space observed; nonperishable foods observed; perishable foods observed; dining area/kitchen equipped with tables and chairs accommodating all clients; additional space was observe for meals; hot water measured at 111 degrees; all smoke detectors were tested by a fire inspector and appear to be in proper working order; carbon monoxide detector observed; fire extinguishers are properly charged; facility maintains a current fire certificate; appropriate forms are posted in view of facility clients; facility does not have any open bodies of water; and, no firearms or weapons are allowed in the facility. The following items were discussed and reviewed by LPA during inspection: 84661 - Reporting Requirements. The county child welfare agency shall prepare and submit to the Department a written report no later than 24 hours after the child's placement reaches the 10-day limit, in addition to all requirements in this section. This application is ready for licensure. LPA Pavia will license the TSCF as of today, 3/11/24. License will be emailed in the next 24-48 hours.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/14/24, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a post-licensing inspection. LPA met with Administrator Aimee Salazar and informed of the purpose of the visit. There were no children currently in care. LPA reviewed one child record and observed it to be complete. 5 staff files were observed to be complete. LPA discussed facility operations with Administrator, who stated staff working at the agency's short-term residential therapeutic program also work here at the temporary shelter care facility. LPA also discussed the quarterly overstay logs, and Administrator confirmed the next report will be sent to LPA at the end of this quarter. LPA toured the facility site and observed the facility to be maintained in safe condition, furniture was observed to be in good condition, dangerous items such as chemicals, medications, or sharp objects were observed to be stored where only accessible to staff, and the bathrooms and kitchen were clean and sanitary. No deficiencies were observed during today's inspection. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator.

met_with: Administrator Aimee Salazar


summary: Facility Evaluation

raw_content:
Narrative:
On 3/25/25 at 11:15AM, Licensing Program Analyst (LPA) Mariah Hawkins arrived to the facility for a required annual inspection. LPA met with Administrator Aimee Salazar and informed of the purpose of the visit. LPA toured the physical plant and observed the facility to be clean, kitchen and bathrooms to be maintained in sanitary condition, and storage areas well-stocked with food, linens, and activity/craft supplies. Chemicals, medications, and sharps were locked and inaccessible to clients. Hot water measured within the permitted range. The first aid kit was complete. All bedrooms had individual beds and clean linens. LPA inspected one client file, five staff files, and documentation of emergency drills. LPA observed all files to be complete. All staff have a background clearance and eligibility to work at this site. All staff have valid first aid and crisis intervention certifications and have received training relevant to the served population. The facility is conducting regular emergency drills. LPA interviewed two staff. Interviews reflected staff are well trained on facility policies and procedures and client rights. No deficiencies were observed during this inspection, and no citations were issued. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, March 4th 2026, Licensing Program Analyst (LPA) Mariah Hawkins visited the facility for a random annual inspection. LPA met with Administrator Aimee Salazar and informed of the purpose of the visit. LPA toured the facility site with Administrator. LPA observed the facility to be clean and tidy. Kitchen, laundry, and bathroom areas are sanitary. There is food supply to provide varied meals and meet the needs of the residents in care. Cleaning solutions and sharps are stored where inaccessible to residents. Spare linens are maintained in hallway cabinets. A variety of activity supplies are available, including books, board games, art supplies, and outdoor play equipment. LPA conducted confidential interviews with two staff members and two former residents. LPA attempted an interview with a current resident, who declined an interview. LPA reviewed one resident file and five personnel files. LPA observed all files to be complete and all files to reflect relevant trainings, current first aid certifications, and valid background clearances. No deficiencies were observed. An exit interview was conducted, and a copy of this report was provided to Administrator.


facility_name: TSCF HASKELL

raw_content:
Narrative:
Confidential statements obtained from Y1, Y2, staff members and other related parties in addition to review of corresponding incident, medical and Police reports indicate a lack of evidence to support allegation that Staff did not prevent youth in care from using felony drugs in the facility. Statements obtained indicate denial of staff having knowledge or was aware C1 possessed Fentanyl when C1 entered the restroom. Facility staff responded appropriately and submitted an incident report to required parties upon discovery. Based on confidential statements and documentary evidence, the allegation is determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations or Interim Licensing Standards (ILS) cited at this time. Exit interview completed. A copy of this report was provided to Facility Representative.

Investigation Findings:
13On January 17, 2024, at 3: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Janet Jackson,Facility Manager to discuss the investigative outcome. On July 21, 2023, Community Care Licensing Division (CCLD) received a complaint referral alleging neglect as a youth resident reportedly overdosed on fentanyl while at the facility. The allegation was referred to CCLD Investigations Branch, Investigator Olivia Spindola. On July 27, 2023, Special Investigator Assistant, Rocio Flores completed the initial complaint notification at the facility and informed of the investigation. The investigation revealed on July 21, 2023, while at the facility, Client #1 (C1) went in the facility's restroom and after several minutes, Staff #1 (S1) entered the restroom when C1 did not answer the restroom's door (see LIC 811, dated 1/17/2024). Staff members (S1 and S2) found C1 unconscious on the restroom's floor. S1 and S2 administered Narcan and CPR to C1 and call 911. C1 was transported by ambulance to the Hospital Emergency room for medical care. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin 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: TSCF HASKELLFACILITY NUMBER: VISIT DATE: 01/17/2024

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

met_with: Janet Jackson


summary: Facility Evaluation

raw_content:
Narrative:
On 12/03/2021 at 1: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Pre-Licensing Inspection. LPA met with the administrator who granted access to the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days to six (6) males ages 13-17 years; Ambulatory only. There are no bodies of water on the premises. The Administrator confirmed that there are no guns or weapons on the premises. LPA- Gray observed the follow during the inspection: TSCF Overview: This is a 1-story 3 bedrooms 2 bath home located in a residential neighborhood. There a living room, dining room, kitchen, staff office and a two (2) car garage. Currently there is not a vehicle utilized to transport the children. The administrator will provide information about the company vehicle later to be inspected to be operating in good condition. Outdoor Area: The activity space is free of hazard materials and debris. LPA observed a staff displayed the utility shut-off valves for gas and water. The Hot Water Heater is enclosed in the basement on the side of the house. LPA observed all windows, screens and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, and several lemon trees and a black metal picnic table. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, emergency disaster plan is inside the office. The personal rights are all posted on the back of each bedroom door. In the dining area there are Grievance forms and a comment box mounted the wall. LIC- Page 1 of The two (2) car garage utilized for extra storage, water, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. There are two (2) freezers, water bottles and Ping Pong table. The Licensee will ensure that the children are always monitored when children are in the garage area. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked office. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with two (2) televisions, and two (2) red cabinets to store electronic games. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The is also an additional freezer located in the garage. The dining table Dining area six (6) chairs. There is book shelf and a cabinet for art supplies. LPA observed coverage trash cans in the kitchen, bathroom and staff office. The laundry room is in the hallway equipped with a washer and dryer, and linen closet is above the washing machine. LPA observed two (2) Fire Extinguishers located in the kitchen and in the staff office fully charged. There are three (3) Bedrooms: Each bedroom twin size beds, with a mattress, clean linen, adequate close and drawer space. Bedroom # 1: Is currently unoccupied equipped with two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows and drapes; observed to be in good condition. Bedroom # 2: Is currently unoccupied equipped with two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows, drapes; observed to be in good condition. Bedroom # 3: Is the Master Bedroom. Is currently unoccupied two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer. There is adequate lighting and the windows, drapes; observed to be in good condition. There a walk-in closet and walk in full-size bathroom with 2 sinks. LIC- Page 2 of Bathrooms: There are two (2) full-sized Bathrooms were inspected and found to be clean. Bathroom #1 is in the Hallway and Bathroom #2 is in the Bedroom #2. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the clients prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff will accompany clients to local recreational facilities based on the rules of the COVID-19. Clients are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The Facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the Ratio present for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA's concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 12/03/ LIC- Page 3 of 3

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 08/23/2022 at 1: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced visit to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Post Licensing Inspection. A Health and safety risk assessment was conducted upon arriving at the facility. LPA met with the Administrator who granted access to the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days, to six (6) children ages 13-17 years; Ambulatory only. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. LPA- Gray observed the follow during the inspection: TSCF Overview: This is a 1-story 3 bedrooms 2 bath home located in a residential neighborhood. There is a living room, dining room, kitchen, staff office and a two (2) car garage. There is vehicle utilized to transport the children; inspected to be operating in good condition. Outdoor Area: The activity space is free of hazard materials and debris. The utility shut-off valves for gas and water Hot water Heater are enclosed in the basement on the side of the house. LPA observed all windows, screens, and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, a black metal picnic table, a lemon tree, and several other trees throughout the back yard area. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, emergency disaster plan is inside the office. The personal rights are all posted on the back of each bedroom door. In the dining area there are Grievance forms, and a comment box mounted the wall. LIC- Page 1 of The two (2) car garage utilized for extra storage, cleaning supplies, water, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. There are two (2) freezers, water bottles extra clothing and supplies. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked office. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with two (2) televisions, and two (2) sofas, two (2) red cabinets and a computer desk. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with top freezer. There is also an additional freezer located in the garage. The dining table Dining area six (6) chairs. There is bookshelf and a cabinet for art supplies. LPA observed coverage trash cans in the kitchen, bathroom, and staff office. The laundry room is in the hallway equipped with a washer and dryer, and the linen closet is above the washing machine. LPA observed two (2) Fire Extinguishers located in the staff office fully charged. There are three (3) Bedrooms: Each bedroom is equipped with two (2) twin size beds, a mattress, clean linen, blankets, adequate drawer space, one (1) walk in closet, sliding windows and drapes; observed to be in good condition. The personal rights are posted on the back of each bedroom door. Bedroom # 1: Is currently occupied observed to be in good condition. Bedroom # 2: Is currently occupied observed to be in good condition. Bedroom # 3: Is the Master Bedroom. Is currently unoccupied; observed to be in good condition. Bathrooms: There are two (2) full-sized bathrooms were inspected and found to be clean. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 is in the hallway between bedrooms. Bathroom #2 is in the Bedroom #2. LIC- Page 2 of There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the clients prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff will accompany clients to local recreational facilities based on the rules of the COVID-19. Clients are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The Facility will operate within license conditions and limitations including capacity limitations. Facility personnel are instructed to report violations of personal rights. Licensee agreed to report changes in the plan of operation affecting service to clients. and any injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the Ratio present for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA concluded the Post License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 08/23/ LIC- Page 3 of 3

met_with: ADMINISTRATOR


summary: Facility Evaluation

raw_content:
Narrative:
On 12/05/2022 at 2: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Annual/Required. LPA met with the administrator who granted access to the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days to six (6) males ages 13-17 years; Ambulatory only. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. LPA-Gray observed the follow during the inspection: TSCF Overview: This is a one (1) story 3 bedrooms 2 bath home located in a residential neighborhood. There a living room, dining room, kitchen, staff office and a two (2) car garage. Currently there is not a vehicle utilized to transport the children. Staff has authorized to transport children in their personal vehicles. Staff has valid drivers license and covered by by County of Los Angeles Risk Management Branch. Outdoor Area: The activity space is free of hazard materials and debris. LPA observed a staff displayed the utility shut-off valves for gas and water. The Hot Water Heater is enclosed in the basement on the side of the house. LPA observed all windows, screens and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, and several lemon trees and a black metal picnic table. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, emergency disaster plan is inside the office, kitchen are posted throughout the facility). The The personal rights are all posted on the back of each bedroom door. In the dining area there are Grievance forms and a comment box mounted the wall. LIC- Page 1 of The two (2) car garage utilized for extra storage, water, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. There are two (2) freezers and water bottles. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked cabinet. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished (2) televisions both are operable only (1) being utilized. There is two (2) red cabinets to store electronic games. Dining room/Kitchen: Observed to be clean and organized; There is 4 burner gas stove; a double door refrigerator top freezer.The is also full freezer and a refrigerator located in the garage. The dining table Dining area six (6) chairs. There is book shelf and a cabinet for art supplies. LPA observed coverage trash cans in the kitchen. The laundry room is in the hallway equipped with a washer and dryer, and linen closet is above the washing machine. LPA observed two (2) Fire Extinguishers located in staff office to prevent children for using it as weapon. There are three (3) Bedrooms: Each bedroom is equipped with two (2) twin size beds, with a mattresses, clean linen, blankets, adequate drawer space and one (1) walk in closet, sliding windows and drapes; observed to be in good condition. The personal rights are posted on the back of each bedroom door. Bedroom # 1: Is currently unoccupied Bedroom # 2: Is currently occupied by one (1) child. Bedroom # 3: Is the Master Bedroom. Is currently unoccupied. There a walk-in closet and walk in full-size bathroom with 2 sinks. LIC- Page 2 of Bathrooms: There are two (2) full sized bathrooms were inspected and found to be clean. Bathroom #1 is in the Hallway and Bathroom #2 is in the Bedroom #2. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the children's prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office in locked cabinet. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and children can use the telephone unless restricted by court order. Based on the behavior, compliance and the children's trauma staff selectively accompany clients to local recreational facilities. Children are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility will operate within license conditions and limitations including capacity limitations. The facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to children. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the ratio present for the capacity of children in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA's concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 12/05/ LIC- Page 3 of 3

met_with: Lead House Manager