summary: Facility Evaluation

raw_content:
Narrative:
On 7/13/22, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit at the facility regarding a plan of correction (POC) for a citation issued on 7/7/22. LPA met with Administrator Lasondra Jones and informed of the purpose of the visit. On 7/7/22, a citation of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section Personal Rights was issued with a POC due date of 7/8/22. As of 7/13/22, the POC has not been submitted, and during visit, Administrator confirmed that the correction had not yet been made. Per Health and Safety Code and California Code of Regulations, Title 22, Section 80054(f), LPA is issuing notification of a civil penalty of $100 per day, for the period of 7/9/22 through 7/13/22, for a total of $500. See LIC 421FC. An exit interview was conducted, appeal rights provided, and a copy of this report left with Administrator Lasondra Jones, whose signature on this form confirms receipt.

met_with: Administrator Lasondra Jones


state: CA

facility_name: ALANA'S HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 8/23/2023, at 10:30AM, Licensing Program Analyst (LPA) Alyssa Ng conducted an unannounced Psychotropic Medication Inspection to the listed facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Ng met with Marvette Simmons, Facility Manager. The facility currently has three clients. Initially when talking to the facility, one client was on psychotropic medication. Of the three clients, no clients meets the criteria of a foster youth currently prescribed psychotropic medications. When reviewing the client file, it was discovered that the client has parental authorization. LPA reviewed five staff files. LPA did not conduct any client interviews due to the client having parental authorization. LPA reviewed the medication, centrally stored medication log including the Medication Administration Record and Psychotropic Medication Administration Record. LPA interviewed two staff members on site to discuss the facility's policies and procedures of operation. No deficiencies are being cited at this time. LPA conducted exit interview with Lasondra Jones, Administrator, at 12: PM whose signature confirms the receipt of this document.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Marvette Simmons, Lasondra Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 2/2/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted an annual/2yr inspection at the facility. LPA met with Facility Manager Patricia McCorkell and informed of the purpose of the visit. LPA toured the facility with staff, conducted confidential interviews with 2 staff and 2 residents, and reviewed facility, personnel, and resident records. LPA observed the facility to be maintained in safe condition and bathrooms and food storage/prep areas to be maintained in sanitary condition. The facility was maintained at a comfortable temperature, and living and storage spaces were clean and tidy. Resident files were observed to be complete. Staff have background clearances and complete files apart from the training records. LPA observed personnel files to be missing documentation of staff training. LPA observed facility manager file to be missing documentation of facility manager training. LPA observed care staff files to be missing documentation of both the 24 hours of initial training and the 40 hours of annual training. LPA issued citations of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Sections 87065(f)(2), 87065.1(d)(5), and 87065.1(e)(7). See attached LIC 809-D pages. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Facility Manager Patricia McCorkell, whose signature on this form confirms receipt.

visit_type: Annual

met_with: Facility Manager Patricia McCorkell


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, May 2nd, 2024 at 10:30AM, a noncompliance conference was held to discuss compliance concerns at the facility. The licensee was informed of the purpose of the meeting. The specific areas of concern were discussed, and a corrective action plan was developed in consultation with the licensee. List of Attendees: - Nelson Martinez, Regional Manager (CCL) - Isabel Diego, Licensing Program Manager (CCL) - Mariah Hawkins, Licensing Program Analyst (CCL) - Lasondra Jones, Director (Licensee) - Philip Ellingberg, Board Member (Licensee) - Kirk Brock, Head of Services (Licensee) - Patricia McCorkell, Facility Manager (Licensee) - Marvette Simmons, Facility Manager (Licensee) - Andrea Bluford (DHCS) - Melissa Fegurgur (Alameda County CFS) - Lashonda Wallace (Contra Costa County CFS) The meeting adjourned at 12PM. A copy of this report was provided to the licensee representatives.

met_with: Director/Administrator Lasondra Jones


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday 6/4/24, Licensing Program Analyst (LPA) Mariah Hawkins made an unannounced case management visit to the facility in order to provide technical advisory support. LPA met with Facility Manager Marvette Simmons and informed of the purpose of the visit. During an investigation and/or inspection of the facility, an area in which technical support may be beneficial was identified. It was learned that the facility has not documented life skills training in utilizing public transportation provided to resident(s) resulting in limited documentation to support that this training was provided. LPA read through the facility's plan of operation / program statement section discussing the facility's plan to provide this training with Facility Manager Marvette Simmons. The plan of operation / program statement also indicates that a daily transportation schedule ensuring youth-specific transportation needs are met is posted in the facility. LPA provided technical support in the form of an advisory to document life skills training and/or summarize residents' transportation plan in the needs and services plan. See LIC Technical Assistance. During the discussion, Facility Manager Marvette Simmons indicated that a transportation schedule is not currently posted. LPA advised that the schedule be posted or that this line in the plan of operation / program statement be revised, as it is not currently a specific requirement for this facility type to post a daily transportation schedule. An exit interview was conducted, appeal rights were discussed, and a copy of this report was left with Facility Manager Marvette Simmons, whose signature on this form confirms receipt.

met_with: Facility Manager Marvette Simmons


summary: Facility Evaluation

raw_content:
Narrative:
On 08/28/24 at 10:45am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced inspection at Alana's House and met with Facility Manager. The purpose of the visit was to conduct a Case Management/Non-Compliance Conference (NCC). On 05/02/2024, Community Care Licensing held a Non-Compliance conference. The purpose of this inspection was to review the progress of the facility since the facility had their NCC. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and during the NCC. The facility is subject to increased unannounced visits to ensure compliance for the next two years. 1) The facility will be subject to increased monitoring by the Department, which may include but is not limited to increased inspections, record reviews, and interviews with facility residents and personnel. LPA Pierotti reviewed 2 staff files and 2 client flies. LPA found the files to be complete and up to date. 2) Beginning the month of this NCC, licensee will submit an updated/current LIC 500 on a quarterly basis to the assigned LPA. LPA Pierotti received an updated LIC 500 on 05/29/24. LPA Pierotti reviewed the current LIC 500 at the facility during the inspection and found it to be up to date and current. 3) Within 30 days of this Noncompliance Conference (NCC), Licensee will have created one (1) separate training binder for the maintenance of training records, including initial training, annual training logs, and facility manager training. Records may be kept in individual personnel files, but copies should then be maintained in the training binder. LPA Pierotti reviewed the training logs for staff and found them to be filed in each staff's personal file. The most recent training conducted was on 08/22/24 for CIP it was 8 hours long. Cont. on 809C 4) Within 60 days of this NCC, Licensee will ensure that each staff member who interacts with residents receives additional training on the California Code of Regulations, Title 22 requirements for (1) Personal Rights; (2) Needs and Services Plans and Modifications to Needs and Services Plan; (3) Reporting Requirements; and (4) Medication Management. The Personal Rights training will be obtained through an outside training program, and the other trainings may be held in-house. The certificates for outside training(s) and the detailed training materials for in-house trainings will be submitted to the licensing agency as well as maintained on site for future training purposes. The licensee shall develop a post-training competency test/evaluation covering the above topics, and completed tests/evaluations for each training participant shall be available for review on site. LPA was sent documentation of trainings completed by facility staff on 05/29/24. The training included Personal Rights from Essential CEU dated 5/28/24 and 5/29/24. Training on Needs and Services Plans, Reporting Requirements, and Medication Management was completed on 5/14/24. 5) Within 30 day of this NCC, licensee will implement staff meetings to be held no less than once a month to review the following topics: (1) Personal Rights, with inclusion of review of personal rights in discussion of facility incidents and/or trends; (2) Needs and Services Plans, with discussion of that month's updated plans for each resident in care; (3) Medication Management; (4) Supervision and Ratios, including discussion of ensuring respectful engagement with residents and fostering a sense of community among residents; (5) Activity Planning, including discussion of sticking to activity calendar, making necessary arrangements ahead of time, requesting residents' input, and consistency in hosting activities to encourage residents' engagement even if they do not initially engage. Meetings will be mandatory, and Licensee will ensure appropriate measures are taken to encourage staff attendance, such as ensuring scheduling is appropriate for all staff, offering multiple sessions to ensure all staff are able to attend, and developing corrective action plans for staff who habitually fail to attend. Each meeting's agenda and list of attendees will be maintained on site and available for review. LPA reviewed that staff meeting logs and agendas and found that the facility has been having monthly meetings and that the meetings review Personal Rights, the facility Program Statement, Reporting Requirements, Medication, Client Files as well as other current things going on at the facility. Cont. on 809C 6) Board meetings will be held no less than once every three months and will include a review of the following: (1) That quarter's incident reports, including trends, corrective actions, and necessary follow-up; (2) Reporting requirements, ensuring all reportable incidents were reported to the appropriate agencies within the required time frames; (3) Needs and Services Plans, ensuring plans are updated every 30 days and developed in consultation with the authorized representative(s) and the resident, as developmentally appropriate and documented if not appropriate; (4) Supervision and Ratios, ensuring the minimum ratios are met, additional staffing as needed has been supplied, and on-call staff are scheduled; (5) Criminal Background Clearances, ensuring the appropriate procedures are followed to ensure all staff receive a background clearance and are listed as cleared on the facility's Guardian roster prior to working on site. Board minutes will be available for review on site. Additionally, within 60 days of this NCC, each member of the board will re-review PUB 326 (Version 08/22) Facts You Need to Know, GH/STRTP Board of Directors or Governing Body and submit a new signed copy of the LIC 9165 (Version 04/22) Board of Director or Governing Body Statement. On 5/29/24, LPA received signed copies of the LIC 9165 from the members of the board. LPA was unable to view the Board Minutes as they were not at the facility. Facility agrees to send the Board Minutes to the LPA by end of business day on 08/30/24. LPA Pierotti discussed the findings of the NCC inspection, and a copy of this report was left with Facility Manager whose signature confirms receipt.

met_with: Marvette Simmons, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/14 at 12:30pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced inspection at Alana's House and met with Facility Manager and Administrator. The purpose of the visit was to conduct a Case Management/Non-Compliance Conference (NCC). On 05/02/2024, Community Care Licensing held a Non-Compliance conference. The purpose of this inspection was to review the progress of the facility since the facility had their NCC. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and during the NCC. The facility is subject to increased unannounced visits to ensure compliance for the next two years. 1)The facility will be subject to increased monitoring by the Department, which may include but is not limited to increased inspections, record reviews, and interviews with facility residents and personnel. 2) Beginning the month of this NCC, licensee will submit an updated/current LIC 500 on a quarterly basis to the assigned LPA. On 12/10/24, LPA observed the LIC 500 in the staff office and found it up to date. 3) Within 30 days of this Noncompliance Conference (NCC), Licensee will have created one (1) separate training binder for the maintenance of training records, including initial training, annual training logs, and facility manager training. Records may be kept in individual personnel files, but copies should then be maintained in the training binder. On 12/10/24, LPA observed all trainings to be held in a separate binder with logs for each training and a description of the training as well as the instructor information. Trainings are conducted on a monthly basis. Cont. on 809C 4) Within 60 days of this NCC, Licensee will ensure that each staff member who interacts with residents receives additional training on the California Code of Regulations, Title 22 requirements for (1) Personal Rights; (2) Needs and Services Plans and Modifications to Needs and Services Plan; (3) Reporting Requirements; and (4) Medication Management. The Personal Rights training will be obtained through an outside training program, and the other trainings may be held in-house. The certificates for outside training(s) and the detailed training materials for in-house trainings will be submitted to the licensing agency as well as maintained on site for future training purposes. The licensee shall develop a post-training competency test/evaluation covering the above topics, and completed tests/evaluations for each training participant shall be available for review on site. LPA was sent documentation of trainings completed by facility staff on 05/29/24. The training included Personal Rights from Essential CEU dated 5/28/24 and 5/29/24. Training on Needs and Services Plans, Reporting Requirements, and Medication Management was completed on 5/14/24. 5) Within 30 day of this NCC, licensee will implement staff meetings to be held no less than once a month to review the following topics: (1) Personal Rights, with inclusion of review of personal rights in discussion of facility incidents and/or trends; (2) Needs and Services Plans, with discussion of that month's updated plans for each resident in care; (3) Medication Management; (4) Supervision and Ratios, including discussion of ensuring respectful engagement with residents and fostering a sense of community among residents; (5) Activity Planning, including discussion of sticking to activity calendar, making necessary arrangements ahead of time, requesting residents' input, and consistency in hosting activities to encourage residents' engagement even if they do not initially engage. Meetings will be mandatory, and Licensee will ensure appropriate measures are taken to encourage staff attendance, such as ensuring scheduling is appropriate for all staff, offering multiple sessions to ensure all staff are able to attend, and developing corrective action plans for staff who habitually fail to attend. Each meeting's agenda and list of attendees will be maintained on site and available for review. On 12/10/24, LPA reviewed the staff meeting logs and agendas and found that the facility has been having monthly meetings and that the meetings review Personal Rights, the facility Program Statement, Reporting Requirements, Medication, Client Files as well as other current things going on at the facility. Continue on LIC809C 6) Board meetings will be held no less than once every three months and will include a review of the following: (1) That quarter's incident reports, including trends, corrective actions, and necessary follow-up; (2) Reporting requirements, ensuring all reportable incidents were reported to the appropriate agencies within the required time frames; (3) Needs and Services Plans, ensuring plans are updated every 30 days and developed in consultation with the authorized representative(s) and the resident, as developmentally appropriate and documented if not appropriate; (4) Supervision and Ratios, ensuring the minimum ratios are met, additional staffing as needed has been supplied, and on-call staff are scheduled; (5) Criminal Background Clearances, ensuring the appropriate procedures are followed to ensure all staff receive a background clearance and are listed as cleared on the facility's Guardian roster prior to working on site. Board minutes will be available for review on site. Additionally, within 60 days of this NCC, each member of the board will re-review PUB 326 (Version 08/22) Facts You Need to Know, GH/STRTP Board of Directors or Governing Body and submit a new signed copy of the LIC 9165 (Version 04/22) Board of Director or Governing Body Statement. On 12/10/24, the Board Meeting minutes were not available for review. Administrator will send the minutes to LPA via email by 12/12/2024. LPA found the facility to be following the conditions of the NCC. An exit interview was conducted and a copy of this report was left with Administrator whose signature confirms receipt.

met_with: Marvette Simmons, Facility Manager LaSondra Jones, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 02/11/2025 at 9:45am, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Simran Nayyar conducted a quarterly case management inspection in accordance with the terms agreed upon during the May Noncompliance Conference (NCC). LPA met with Cynthia Alvarez, Staff and explained the purpose of the visit. At 11:15am, LaSondra Jones, Administrator, joined the inspection. As outlined in the NCC terms and previous inspections, several requirements were reviewed. The LIC 500 was up to date. Staff training records are in compliance, with all staff fully trained at the time of hire and receiving additional training on a quarterly basis. Staff Meeting records showed meetings are held on a monthly basis and the last staff meeting was on 01/28/2025. Staff were trained on Compliance. Board Meeting minutes were available for review and LPA found that the last Board Meeting was on January 23, 2025. No deficiencies were found. LPAs reviewed 3 client files and found that 2 clients do not have signed Emergency Medical Treatment Consent Forms. Through record review and interviews, it was found that one client refuses to sign all documents and the other client was just admitted to the facility and paperwork is still being filled out. LPA is issuing a Technical Violation for Children's Records Interim Licensing Standards 87070(b)(12). LPAs reviewed 4 staff flies. All staff files contained the necessary forms and were up to date. No deficiencies were found. LPAs toured the facility and found it to be clean and in good repair. There were two days of perishable foods and seven days non-perishable foods present. LPAs observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. No deficiencies were found. Continue on LIC809C LPA found the facility to be in compliance and following the conditions of the NCC. An exit interview was conducted, and a copy of this report was left with Administrator whose signature confirms receipt.

met_with: Cynthia Alvarez, Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 07/23/25 at 10:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Psychotropic Medications inspection at the licensed facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). LPA met with LaSondra Jones, Facility Administrator. At the time of the inspection, there were 3 client and 3 staff members in the facility. The facility has a census of 3 clients. The facility has 0 clients that meet the criteria for the SB Psychotropic Medication Inspection, as clients are not taking psychotropic medications. LPA reviewed staff files and training records for 5 staff members. LPA observed that all staff have completed initial training for psychotropic medication and have been receiving ongoing psychotropic medication training on a quarterly basis. LPA conducted 3 staff interviews. LPA conducted a walk through of the facility. LPA did not observe any physical plant deficiencies. At this time, there are no deficiencies. LPA conducted an exit interview with LaSondra Jones, Facility Administrator, whose signature confirms the receipt of this document.

met_with: LaSondra Jones, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 08/12/2025 at 10:30am , Licensing Program Analyst (LPA) Kristin Pierotti and LPA Hanako Primer conducted a quarterly case management inspection in accordance with the terms agreed upon during the May Noncompliance Conference (NCC). LPAs met with Marvette Simmons, Facility Manager and informed of the purpose of the inspection. As outlined in the NCC terms and previous inspections, several requirements were reviewed. The LIC 500 was up to date with all staff having full criminal background clearances. Staff training records are in compliance with all staff fully trained at the time of hire and receiving additional training on a monthly basis. Staff Meeting records showed meetings are held on a monthly basis and the last staff meeting was on July 30, 2025. Staff were trained on Cultural Competency. Staff also took a 2 part "Being Trauma Informed" training on August 5, 2025 and August 7, 2025. LPAs were unable to review the Board Meeting minutes at the time of the inspection. Facility Administrator, LaSondra Jones, will send the minutes to LPA Pierotti by end of day for review via email. LPAs reviewed 3 resident records and found them to contain current emergency contact information, complete care plans, and cash records. LPAs observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. Sharps and chemicals are stored where inaccessible to the residents. At this time, no deficiencies were found. LPAs found the facility to be following the conditions of the NCC. An exit interview was conducted and a copy of this report was left with Marvette Simmons, Facility Manager, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/09/2025 at 10:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced random annual inspection at the facility. Please note this LIC809 shows "Type of Visit" as "Post-Licensing", this is an error with the Field Automation System (FAS). LPA met with Marvette Simmons, Facility Manager and informed of the purpose of the visit. LPA used the CARE Inspection Tool and conducted a tour of the facility site, review of 4 personnel records, and 3 resident records. LPA conducted confidential interviews with 2 staff members and 0 residents as the resident present during the inspection declined to be interviewed. LPA observed the facility to be in good condition, clean, and well organized. Kitchen and bathrooms were sanitary. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. During the time of the inspection, the facility was having maintenance conducted in a bathroom to fix the shower knob. The facility currently has 3 residents and each resident has their own bedroom with individual beds and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPA observed personnel and resident records to be complete and had all necessary documents. Staff have full background clearances, complete training records, and first aid training certifications. Residents' records contain current emergency contact information, complete care plans, and cash records. Residents are not currently taking any medications. Continue on LIC812C Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and intervention procedures. LPA observed residents to be provided 1:1 supervision, to be dressed in well-fitting, appropriate, and clean clothes, and to be appear comfortable in care. No deficiencies were observed at this time. An exit interview was conducted and a copy of this report was left with Marvette Simmons whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/19/2025 at 11: AM, Licensing Program Analysts (LPAs) Mona Lam and Amee Li conducted a quarterly case management inspection in accordance with the terms agreed upon during the May Noncompliance Conference (NCC). LPAs met with Patricia McCorkell, Facility Manager, and explained the purpose of the inspection. At the time of the inspection, there are three clients in care. As outlined in the NCC terms and previous inspections, several requirements were reviewed. Staff training records are in compliance, with all staff fully trained at the time of hire and receiving additional training on a monthly basis. Staff Meeting records showed meetings are held monthly, with the last staff meeting on December 17, 2025. Staff received medication training on December 17, 2025. LPAs reviewed six staff flies. All staff files contained the necessary forms and were up to date. No deficiencies were found. LPAs reviewed three client files and found them to contain current emergency contact information and cash records. LPAs were unable to review the LIC 500, Board Meeting minutes, and current clients' Needs and Services Plans for November 2025 at the time of the inspection. LPAs requested for the previously listed forms to be sent by PM on 12/19/2025 for review via email. LPAs observed the facility to be in good repair, clean, and well organized. Kitchen and bathrooms are sanitary. Sharps and chemicals are stored where inaccessible to the residents. At this time, no deficiencies were found. An exit interview was conducted, and a copy of this report was left with Patricia McCorkell, Facility Manager, whose signature confirms receipt.

met_with: Patricia McCorkell, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 05/20/2025 at 12:00pm, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Hanako Primer conducted a quarterly case management inspection in accordance with the terms agreed upon during the May Noncompliance Conference (NCC). LPA met with LaSondra Jones, Administrator, joined the inspection. As outlined in the NCC terms and previous inspections, several requirements were reviewed. The LIC 500 was up to date with all staff having full criminal background clearances. Staff training records are in compliance, with all staff fully trained at the time of hire and receiving additional training on a monthly basis.Staff Meeting records showed meetings are held on a monthly basis and the last staff meeting was on 04/29/2025. Staff were trained on Mandatory Reporting to Community Supporting conducted by Catalyst Center. LPA was unable to review the Board Minutes due to the most recent meeting being held on 05/20/25 at 7:30am. Licensee will send the minutes to LPA Pierotti via email once they have been transcribed. LPAs reviewed 2 client files. LPAs observed C1's LIC405 was not filled out correctly. LPAs observed Incident Reports that have not been sent to the Department for C1, C2 and C3. At this time, LPA is issuing a citation for California Code of Regulation (CCR), Title 22, Division 6, Chapter 1, Article 6, Section 80061(b) Reporting Requirements. LPA also found an area in which technical assistance was provided in the form of a Technical Violation. LPA found the facility to be following the conditions of the NCC. An exit interview was conducted, appeal rights discussed, and a copy of this report, the LIC809D, and the LIC9102 was left with Administrator, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Alyssa Ng on 09/07/2022 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Ng met with Cynthia Alvarez, Direct Care Staff and inspected the facility inside and out. LPA reviewed 1 of child's records and 2 of staff personnel files on site at the facility. There were two staff members and 1 client present at the time of the inspection. The current census is five clients, two of the clients are currently on AWOL, one client is in the hospital, one client at school, and the last client was in their bedroom. The client that was in their bedroom was not on any psychotropic medication. LPA reviewed 1 of child's psychotropic medications and medication records. LPA interviewed 1 of staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 0 of children currently prescribed psychotropic medication. During the inspection the LPA observed 2 deficiencies (see attached 809D), plan of corrections were discussed and appeal rights were provided. LPA provided a copy of this licensing report to Cynthia Alvarez, Direct Care Staff.

met_with: Cynthia Alvarez


summary: Facility Evaluation

raw_content:
Narrative:
On 11/18/22 at 12: PM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to listed facility. The purpose of the is inspection is to conduct a case management regarding reporting requirements and criminal record clearances. During a review of the guardian system, it was observed that S1 (see LIC 811 dated 11/18/2022) is not criminally record cleared to work in the facility. A letter was sent to the facility as well as S1 concerning this. Facility is being cited for violation of the Short Term Residential Therapeutic Program (STRTP), Interim Licensing Standards (ILS), Version 4, Section 80019(e)(1): Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. During a file review, LPA Belfield observed at least three incidents were not reported to the department including incidents involving Law Enforcement. Facility is being cited for violation of the Short Term Residential Therapeutic Program (STRTP), Interim Licensing Standards (ILS), Version 4, Section 80061(b)(1) Reporting Requirements. (b)Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified .......shall be submitted to the licensing agency within seven days following the occurrence of such event, on the attached D page. An exit interview was conducted, and a copy of this report was given to Patricia McCorkell, Facility Manager.

met_with: Patricia McCorkell


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 1/18/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility to give notice of deficiencies found during the course of an investigation at the facility. LPA met with Facility Manager Patricia McCorkell and informed of the purpose of the visit. See LIC Confidential Names for names of all referenced individuals. As a result of the investigation, LPA issued a citation of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5, Section 87072(c)(15), which states residents have the right "to be accorded dignity in their personal relationships with staff and other persons." The facility was cited previously cited on 04/10/2023 when this same requirement was listed under 87072(c)(10) under ILS Version 4. Despite the revision in code number in ILS Version 5, the requirement is the same. Therefore, LPA is assessing a civil penalty of $250 for repeat violation within 12 months. See LIC 421FC dated 1/18/24. Additionally, LPA observed the following deficiencies. On 12/19/23, there were four residents in care and only one staff on shift. LPA verified that the minimum ratio for this facility is 1 staff to 3 residents, which was not followed. LPA is issuing a citation of STRTP ILS Section 87065.5(a)(1). On 12/19/23, LPA obtained copies of the needs and services plans in the residents' files. During LPA's review, LPA observed that R1's needs and services plans include the incorrect name for R1 and not the government nor preferred name for R1. Also, LPA observed that the plan developed shortly after a report of staff speaking inappropriately was made stated that R1 had a history of making false allegations despite no previous mention of this challenge in prior plans. See Page 2. PAGE Further, based on confidential interviews and record review, evidence indicates that the resident was not consulted in the development of their plan for multiple months. The record for R1 was missing plans for May, June, July, and August 2023, and the plans that were in R1's file were missing either R1's or R1's authorized representative's signature or documentation of the signatures being pending. LPA is issuing citations of STRTP ILS Sections 87068.2(b), 87068.2(g), 87068.3(a), and 87068.3(b). During LPA's review of residents' clinical notes, LPA observed the complete record, as LPA requested, reflected that multiple weeks were missed, and confidential interviews reflect that weekly individual and group sessions, as indicated in the plan of operation and activity calendars posted in the facility, are not being conducted. LPA is issuing a citation of STRTP ILS Section 87022(f). Additionally, based on confidential interviews and record review, the facility's monthly activity calendar posted in the facility is not being followed, and regular outings and therapeutic activities are not being provided. LPA is issuing a citation of STRTP ILS Section 87079(a). On 12/19/23, LPA obtained copies of resident records and upon review observed that R1, R2, R3 and R4's LIC 613B Personal Rights forms were outdated and thus missing newer personal rights and were not signed by the authorized representatives. LPA reviewed resident files during today's visit and observed this deficiency to still exist. LPA is issuing a citation of STRTP ILS Section 87072(b)(2)(B). On 12/19/23, LPA obtained copies of resident records and upon review observed that R3 and R4's LIC Physician's Reports (medical assessment) were blank. Both residents were placed over 90 days prior to LPA's visit date, and the assessment is to be completed within 30 days. LPA reviewed resident files during today's visit and observed this deficiency to still exist for R3. LPA is issuing a citation of STRTP ILS Section 80069(a). See Page 3. PAGE On 12/19/23, LPA obtained a copy of of the facility license, which was prominently displayed on the bulletin board hanging in the main floor hallway. The license was the provisional license, which expired 6/15/22. LPA verified in internal records that the facility was issued their current, valid license on 6/6/22. LPA is issuing a citation of STRTP ILS Section 87009(a). On 12/19/23, LPA obtained a copy of the LIC 500, which was prominently displayed on the bulletin board hanging in the main floor hallway. It was dated 08/10/2022 and did not include two staff currently working. LPA is issuing a citation of STRTP ILS Section 87066(b)(3). On 1/18/24, LPA requested to see personnel records for S8, which were completed as part of a corrective action plan for the staff member. LPA was informed that the records were not on site and could not be brought to the facility due to the administrator being unavailable on this day. LPA is issuing a citation of STRTP ILS Section 80066(e). Lastly, LPA's review of submitted time sheets reflects that the administrator was on site less than 20 hours a week during the period of November 2023 to December 2023, as the timesheets reflect 17 hours worked the week of 11/20/23, 18 hours worked the week of 11/27/23, 8 hours worked the week of 12/25/23, and no records of hours worked were submitted for the weeks of 12/11/23 and 12/18/23. LPA is issuing a citation of STRTP ILS Section 87064(b)(1). Please see the attached LIC 809-D pages for citation details and the details and due dates for each plan of correction. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Facility Manager Patricia McCorkell, whose signature on this form confirms receipt.

Deficiencies:
87072: (B) A written copy of these rights;

title:
Personal Rights
(b)(2) Pursuant to subdivision (b)(1), the licensee shall provide the following information

description: (B) A written copy of these rights;


summary: Facility Evaluation

raw_content:
Narrative:
On 02/20/2026 at 10: AM Licensing Program Analysts (LPAs) Mona Lam and Amee Li conducted a quarterly case management inspection in accordance with the terms agreed upon during the May Noncompliance Conference (NCC). LPAs met with Patricia McCorkell, Facility Manager and explained the purpose of the inspection. At the time of the inspection, there are three clients in care, one client present, two clients AWOL, and one staff present. As outlined in the NCC terms and previous inspections, several requirements were reviewed. Staff training records are in compliance, with all staff fully trained at the time of hire and receiving additional training on a monthly basis. Staff meeting records showed meetings are held monthly, with the last staff meeting on 01/30/2026. Staff received STRTP Mental Health Program Training via Catalyst Center Learn Up on 01/30/2026. LPAs reviewed five staff files. Five out of five staff files contained the necessary forms and were up to date. No deficiencies were found. LPAs reviewed three client files and found them to contain needs and services plans for January 2026, current emergency contact information, and cash records. LPAs observed the LIC500 posted on the wall, dated 01/20/2024 and the LIC500 maintained in facility staff office, dated 12/20/2025. Through interview, LPAs found that facility currently uses the same schedule as the LIC500 dated 12/20/2025, but did not update the date. LPAs advised facility to update and post the current LIC500. Continued on LIC 809C. LPAs were unable to review board meeting minutes and personal rights training at the time of the inspection. LPAs requested for the above listed documents to be sent by PM on 02/23/2026 to LPA Li for review via email. LPAs conducted a facility walkthrough. LPAs observed the facility to be clean and in good repair. Kitchen and bathrooms are sanitary. Sharps and chemicals are stored where inaccessible to the residents. At this time, no deficiencies were found. An exit interview was conducted and a copy of this report was left with Patricia McCorkell, Facility Manager, whose signature below confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026 at 10: AM, Licensing Program Analysts (LPAs) Amee Li and Mona Lam conducted an unannounced case management inspection at the above-listed facility. LPAs met with Marvette Simmons, Facility Manager and explained the purpose of the inspection. At the time of the inspection, two clients and two staff members are present. Administrator LaSondra Jones joined the conversation via phone call. LPAs conducted a physical plant inspection and found the facility to be in good repair. When LPA Li requested incident reports (IRs) for incidents occurring in January 2026, facility sent LPA eight IRs. However, there were only two IRs for January 2026 that had been sent to Licensing via the designated IR inbox. On 02/27/2026, LPA Li called Administrator LaSondra Jones about this discrepancy and requested for IRs sent via email to the designated inbox to be forwarded to LPA Li. Administrator forwarded one email for January 2026 to LPA Li and stated that she was unable to locate emails sent for the rest of the January 2026 incidents. Administrator stated that they take full responsibility for the missing IRs. Additionally, upon reviewing January shift notes, LPA Li found incidents that should have but had not been reported to Licensing. One Type B deficiency was issued under California Code of Regulations (CCR) 80061(b) and a Plan of Correction (POC) was developed with staff. (See LIC 809D.) LPAs reviewed facility compliance history and observed that the facility was previously issued a deficiency for reporting requirements within the past twelve months, on 05/20/2025. Therefore, one immediate civil penalty of $250 was assessed for the repeat violation, with the potential of an additional $100 per day after the POC due date until the deficiency is corrected. (See LIC 421FC.) (Continued on LIC 809C.) During the inspection, one Type B deficiency was issued and one immediate civil penalty for repeat violation was assessed. An exit interview was conducted, appeal rights given, and a copy of this report was provided to Marvette Simmons, Facility Manager, whose signature below confirms receipt.


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
LPAs conducted a physical plant inspection and found the facility to be in good repair. At the time of this inspection, no Title 22 deficiencies were observed regarding this allegation. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Marvette Simmons, Facility Manager whose signature below confirms receipt.

Investigation Findings:
13On March 11, 2026, at 10: AM, Licensing Program Analysts (LPAs) Amee Li and Mona Lam conducted an unannounced inspection at the above listed facility with the purpose of delivering complaint findings for the above allegation. LPAs met with Marvette Simmons, Facility Manager and explained the purpose of the visit. During the inspection, two clients and two staff members were present. One client was at their court meeting. Administrator LaSondra Jones joined the conversation via phone call. During the course of the investigation, LPA Li conducted six staff interviews, inspected shift notes, and reviewed facility program statement and compliance history. LPA Li found that staff members' accounts did not corroborate the details of the allegation. Staff members' statements corroborated the program statement regarding facility policies for obtaining medical attention for youth and shift notes regarding the events that occurred when client returned from AWOL. Three out of three clients declined or were unable to interview. 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. (Continued on LIC9099C.) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kristin Pierotti LICENSING EVALUATOR NAME: Amee Li LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: ALANA'S HOUSEFACILITY NUMBER: VISIT DATE: 03/11/2026

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


facility_name: ALL OF GOD'S CHILDREN'S GROUP HOME

raw_content:
Narrative:
Administrator stated she attempted to do the best she could regarding staffing and ensuring clients and the staff member were safe. Administrator stated CCL and county representatives were verbally notified of the issues and concerns regarding the health and safety of the facility. Administrator admitted that she was not provided a waiver by CCL staff in regards to the inadequate staffing level. Information obtained from CCL staff corroborated that no waiver was requested or approved to excuse the one staff to seven clients. CCL staff stated information was provided regarding concerns pertaining to the Covid-19 outbreak at the facilities, but not regarding staffing issues. It was also stated that the facility had not had any previous deficiencies regarding staffing levels. Additional information provided stated there were concerns regarding staffing levels, but additional staff was added to the schedule after the health and safety of the facility was restored. Based on interviews and information obtained, the allegation that the facility is not operating per client to staff ratio may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. Exit interview conducted and a copy of the report will be provided to the representative. Signed copies will be placed in the complaint file.

Investigation Findings:
13Licensing Program Analyst (LPA) Jazmond Harris provided the findings for the investigation pertaining to the listed allegation to Administrator, Cheryl Williamson Jones via phone, due to the Covid 19 pandemic. On December 28, 2020 at 3: PM, LPA Harris initiated the complaint investigation with Administrator and no immediate deficiencies were noted. LPA conducted interviews with Administrator, Child Care Counselor, Licensing Program Manager (LPM), Jennifer Smith, and LPA Belinda Torres. On December 17, 2020, Community Care Licensing (CCL), received information which stated Facility is not operating per client to staff ratio. It was reported that one staff member provided care and supervision to seven clients during a time period when the staff and clients contracted Covid-19. It was reported that one staff member was required to work a 27 hour shift supervising seven clients. Information obtained from Administrator stated that due to the clients and staff m/embers contracting Covid-19, only one staff was able and willing to provide care and supervision to the clients. Administrator stated due to personal reasons, she was unable to be present inside the facility, but was outside of the facility in case of an emergency. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Jazmond D Harris 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 05/06/2021

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

met_with: Administrator-Cheryl Williamson Jones


raw_content:
Narrative:
Confidential interviews reported that staff did not believe that C1 needed to be seen by a doctor or to be taken to the ER for injury as it was a superficial cut on the toe. The Department also received an allegation that staff did not assist youth with their therapy appointment. Confidential interviews reported that C1 missed one appointment on 10/07/2021 and was 30 minutes late to two previous appointments. Confidential interviews revealed that C1 did not have a therapy appointment on 10/07/2021 but had a WRAP appointment at home and a CFT appointment held over Zoom. Confidential interviews further revealed that C1 did not miss either of these appointments; however, C1 was late for the CFT as the Zoom had been changed and needed to get the correct meeting code. Confidential interviews also revealed that if C1 did not want to attend the therapy appointments, the staff would not make C1 attend them. Based on confidential interviews and record reviews, the allegations that staff did not seek medical attention for youth in care and staff did not assist youth with their therapy appointment may have occurred, however, it is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated. A copy of this report and appeal rights were given to All of God's Children's Group Home Child Care Worker Laquitta Forham

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

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

met_with: Laquitta Fordham


raw_content:
Narrative:
During the course of confidential interviews, it was reported to the LPA C1 and C2 were playing together during the early evening on 09/15/21. C2 got upset because C1 broke C2's doll. C2 called C1 a derogatory name. C1 started to tantrum and went outside in the facility van. C1 then went into the living room and was yelling and screaming at the other clients. C2 was sitting on the couch. Staff #1 (S1) was standing in between C1 and C2 in order to separate the clients. C1 then grabbed a computer keyboard from the staff computer station in the living room. C1 threw the keyboard at C2 hitting C2 on the back of the head. S1 sent the clients to another room for safety while C1 continued to tantrum and walk around the facility. S1 called the administrator to report the incident. Information from confidential interviews also stated that the administrator arrived at the facility and transported C2 to the emergency room as C2's head was bleeding. It was further reported to the LPA, C1 and C2 normally got along with each other. C1 was prone to tantrums but had never physically attacked another client prior to this incident. According to the unusual incident/injury report, C1 was taken to Riverside County Regional Medical Center and diagnosed with an abrasion to the scalp. The report also indicated C1 was 11 years old, five feet in height and weighed 166 pounds. C2 was eight years old, 4' 5" in height and weighed 60 pounds. C1 constantly engaged in frequent fighting and would hit and kick both clients and staff. C1 would use C1's size to intimidate clients and staff that were small in stature. A Day Notice for Removal was given by the facility for C1. However, other information stated C1 had punched C2 on the stomach during a previous incident. C1 was very aggressive and unable to manage their behavior. C1 was like a "tornado" when angry and the facility was unable to manage C1's behaviors. Based on confidential interviews and document review, the allegation S1 did not prevent youth from engaging in a physical altercation may have occurred, however, is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report and appeal rights were provided to La'Cobra Anderson.

Investigation Findings:
13On 08/31/22 at 10: AM, Licensing Program Analyst (LPA) Belinda Torres met with La'Cobra Anderson, Administrative Assistant, for the purpose of issuing the investigative finding to the allegation listed above. The LPA inspected the facility on 09/21/21 at 2: PM and no safety concerns were observed. During the course of the investigation, the LPA conducted confidential interviews with five out of five clients, two staff and a San Bernardino County Social Worker (CSW). The LPA attempted to interview two other staff but was unsuccessful in making contact as the staff are no longer employed with the licensee. On 09/17/21, Community Care Licensing (CCL) received a complaint alleging staff did not prevent youth from engaging in a physical altercation. It was reported client #1 (C1) engaged in a physical altercation with client #2 (C2) on 09/15/21. It was disclosed that C1 hit C2 on the back of the head with a keyboard. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Belinda Torres 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 08/31/2022

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

met_with: La'Cobra Anderson


raw_content:
Narrative:
It was further reported some of the fruits S1 bought were bad. One time some apples had mold on them and staff threw them away. S1 reported to the LPA she has seen overly ripened bananas on several occasions and thrown them away. S1 does not keep rotten food at the facility. S1's office in the STRTP so she is present on a daily basis. S1 stated she is sure there was rotten food however, she does not buy rotten fruit. S1 reported S2 buys the groceries for the facility. Staff take a picture of each meal for seven days because food has come up missing since the COVID-19 pandemic. During the course of the investigation, confidential interviews were conducted. It was reported to the LPA, S2 purchased groceries every Tuesday and Friday. Fresh fruit were always purchased on Tuesdays and Fridays. The fruit would rot if nobody ate it but the fruit usually ran out quickly. If there is spoiled fruit, the staff are expected to throw it away. It was also reported the staff buy green bananas that are starting to ripen. The LPA observed the food inventory and took pictures of the inventory, during the LPA's unannounced inspection on 10/28/21. The LPA observed a basket on the kitchen counter with approximately eight fresh oranges. The LPA verified the food supplies for that day's dinner menu was present. The food inventory was sufficient. The LPA requested the meal pictures from the last week of September 2021 and the first week of October 2021 and the grocery receipts from 09/01/21-10/15/21. The facility submitted to the LPA meal pictures for the week of 09/27/21-10/05/21. A total of six pictures were received, however it appeared they were of dinner ingredients only. There was no fresh fruit in the pictures. The facility submitted to the LPA grocery receipts from 09/10/21-10/31/21. The receipts showed various fresh fruits such as bananas, grapes, oranges, blueberries, and raspberries were purchased. Based on confidential interviews and document review, the allegation S1 buys food for the clients but sometimes the food isn't adequate enough for them to eat 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 at this time. An exit interview was conducted and a copy of this report and appeal rights were provided to LaQuitta Fordham.

Investigation Findings:
13On 10/21/22 at 2: PM, Licensing Program Analyst (LPA) Belinda Torres met with LaQuitta Fordham, Child Counselor, for the purpose of issuing the investigative finding to the allegation listed above. The LPA inspected the facility on 10/28/21 at 2: PM and no safety concerns were observed. During the course of the investigation, the LPA conducted confidential interviews with one out of five clients and two staff. On 10/21/21, Community Care Licensing (CCL) received a complaint alleging the facility did not provide food that was of the quality necessary to meet the needs of the clients. It was reported Cheryl Williamson-Jones, Administrator (staff #1-S1), buys food for the clients but sometimes the food she buys isn't adequate enough for them to eat. On 10/03/21, a hand of bananas fell apart in the sink. A picture of some bananas, in a sink, that were black in color and had fallen off of the stem was received by CCL. The bananas had been purchased on 10/01/21. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Belinda Torres 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 10/21/2022

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

met_with: LaQuitta Fordham


raw_content:
Narrative:
S2 grabbed C1 by the arm and pushed C1 down onto the bed. S2 also grabbed C1 to try and force C1 out of the room. S2 reported to the LPA, the staff are not supposed to perform manual restraints as All of God's Children's Group Home is a hands-off facility. S2 denied the allegation. S2 reported to the LPA, C1 did not want to give up C1's Chromebook as a consequence. S2 stated she was nowhere near C1. S2 was standing in the threshold of C1's bedroom door. C1 was on C1's bed. S2 told C1 to give the Chromebook to S2 and C1 did not want to. S2 stated she could not remember anything else about the incident as, "There were a lot of situations." S2 could not remember who else was working as, "There were a lot of situations." Based on confidential interviews, the preponderance of evidence standard has been met and the allegation S1 restrained C1 is substantiated. Facility is cited for violation of Interim Licensing Standards Short-Term Therapeutic Program, Articles 1 through Section 87072(c)(11) Personal Rights. An exit interview was conducted and a copy of this report, LIC Proof of Correction(s), LIC Confidential Names and appeal rights was provided to LaCobra Curry. C2 tried to run out of the facility and S1 dragged C2 by C2's hair and pulled C2 back inside. During the course of the investigation, confidential witnesses stated S1 accidentally scratched C1. C1 was trying to get in another client's room. The other client did not want C1 in the room. S1 stood in the other client's bedroom entrance to block C1 from entering. C1 started to swing at S1. S1 put S1's hand out directly in front of S1 to block C1's swings. S1 accidentally scratched C1 with S1's nails. S1 gave C1 an ice pack and wrote up an incident report. The LPA did not receive any evidence to show S1 pushed C1 or the scratch was an intentional act. S2 reported to the LPA she administered C1's medications all the time. S2 could not remember the names of the medications or what they were for. S2 denied giving C1 medication to make C1 sleep. A confidential witness reported C1 did not take any medication for sleep while at the facility. The LPA requested C1's medication logs from the facility but the administrator was unable to locate them. The LPA did not receive any evidence to support the allegations S1 slapped C2's leg when C2 did not want to take C2's medication or S1 dragged C2 by C2's hair and pulled C2 back inside. S1 worked the nocturnal shift which was from 10 or 11 p.m. to 7 a.m. When S1 arrived to work, the clients were already asleep. The AM (day) shift were the only ones that administered the medications. Based on confidential interviews, the allegations S1 knocked C1 to the ground and C1 sustained a scratch to the face, S1 refused to report the incident, S2 overdosed C1 with medication, S1 slapped C2's leg and dragged C2 by the hair 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 at this time. An exit interview was conducted and a copy of this report and appeal rights were provided to LaCobra Curry.

Investigation Findings:
13On 03/03/23 at 02: PM, Licensing Program Analyst (LPA) Belinda Torres met with LaCobra Curry, Administrative Assistant, for the purpose of issuing the investigative finding to the allegation listed above. The LPA inspected the facility on 04/29/22 at 1: PM and no safety concerns were observed. During the course of the investigation, the LPA conducted confidential interviews with five out of five clients, five staff and a county social worker. On 04/20/22, Community Care Licensing (CCL) received a complaint alleging staff #2 (S2) restrained client #1 (C1) on 04/14/22. It was reported S2 pushed C1 down on the bed and held C1's arms down. During the course of the investigation, confidential witnesses stated S2 asked C1 for C1's Chromebook as a consequence. C1 refused and ran to C1's room with the Chromebook. S2 followed C1. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Belinda Torres 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 03/03/2023

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: LaCobra Curry


raw_content:
Narrative:
Staff also try to de-escalate the clients before they start fighting. The staff issue consequences such as the clients losing privileges for a day, electronics are taken away, no sweet snack and no outings for the day. It was further reported to the LPA, C1 steals, puts hands on the staff, fights with the clients, tantrums and does property destruction. C1 would run around a lot, had fits, would jump off C1's bed and was hyperactive. Sometimes C1 would sustain injuries when acting out. The LPA did not receive any evidence to support C1 sustained scratches to the elbow from another client. However, it was disclosed to the LPA that C1 sustained scratches to C1's back when C1 fought with C1's roommate. The roommate slapped C1 on the back with a toy stroller. Confidential interviews indicated that C1 and the roommate had a verbal altercation in the study area while two staff were present. Staff attempted to intervene, however, the roommate acted fast and hit C1 with the toy stroller. The staff sent the roommate to the room and gave C1 an ice pack. Based on confidential interviews, the allegations a client at the facility scratched C1 on the elbow, C1 fought with a client and the client hit C1 due to a lack of supervision 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 at this time. An exit interview was conducted and a copy of this report and appeal rights were provided to LaCobra Curry.

Investigation Findings:
13On 03/03/23 at 2: PM, Licensing Program Analyst (LPA) Belinda Torres met with LaCobra Curry, Administrative Assistant, for the purpose of issuing the investigative finding to the allegations listed above. The LPA inspected the facility on 04/29/22 at 1: PM and no safety concerns were observed. During the course of the investigation, the LPA conducted confidential interviews with five out of five clients, four staff and a county social worker. On 04/21/22, Community Care Licensing (CCL) received a complaint alleging on 04/21/22 a client at the facility scratched C1 on the elbow, C1 fought with a client and the client hit C1. During the course of confidential interviews, the LPA received consistent information the staff intervened when the clients fought with each other. The staff separate the clients. The staff have the clients take space and do conflict resolution afterwards. The staff remind the clients of their coping skills. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Belinda Torres 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 03/03/2023

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


raw_content:
Narrative:
Other confidential interviews disclosed that staff will yell and make rude comments. Additionally, information received from confidential interviews did not express any concerns to CSW's during visits in the home. There were no witnesses that could confirm minors were being yelled at in the home, and child interviews could not provide sufficient details as to when, where, or why they were yelled at. Regarding the allegation that minor is being required to supervise other minors in care, confidential interviews stated that staff are always present at all times and children were not left in the supervision of other minors. When unannounced visits were conducted by CSW's there was staff present in the home providing supervision to the minors in care. Other information received stated that the allegation was true and that staff would leave room the room with foster children present. LPA received inconsistent information regarding the allegations. Based on interviews and confidential information obtained during the course of this investigation, the allegations that the minors are being yelled at while in care and minor is being required to supervise other minors in care, may have occurred, however is not supported, or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report along with LIC 811 was provided to Administrator Assistant, La Cobra Curry and appeal rights were discussed and provided.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Emina Preciado 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 03/07/2023

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

met_with: La Cobra Curry, Administrator Assistant


raw_content:
Narrative:
it was stated the staff never threaten any of the clients in care. Confidential interviews disclosed that staff would threaten to take away privileges for misbehaving. Clients disclosed they have good rapport with the staff. Based on confidential interviews, the allegation staff threaten a minor while in care may have occurred or may be valid, however, there was not a preponderance of evidence to support or deny the allegation. Therefore, the allegation is unsubstantiated at this time. Copy of this report, Confidential Names (LIC 811) and appeal rights were discussed and provided to XXXXXX

Investigation Findings:
13On June 21, 2022, Licensing Program Analyst (LPA) Karen Beal arrived at All of God's Children's (AOGC) and met with Cheryl Williamson. The purpose of this visit was to deliver the investigative finding alleging staff threaten a minor while in care. On September 19, 2022, Community Care Licensing (CCL) received a complaint alleging that a staff threaten a minor while in care. On 09/28/22 at 10: AM Licensing Program Analyst (LPA), Belinda Torres, met with Cheryl Williamson-Jones, Administrator, in regard to the allegation listed above. During this inspection, the LPA conducted a confidential interview and obtained copies of pertinent documentation. On May 22, 2023, LPA Beal arrived at AOGC and conducted two interviews On April 20, 2023, LPA Beal conducted collateral interviews C1, C2 and C3. During the investigation and confidential interviews UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 06/19/2023

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

met_with: Administrator, Cheryl Williamson


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Continued from LIC On April 20, 2023, LPA Beal conducted three collateral interviews (C1, C2, and C3). Regarding the facility is not in clean, sanitary and in good repair, confidential interviews disclosed chores are assigned. Such as, cleaning bedrooms, bathrooms, common areas and taking out the trash. Confidential interview disclosed, a housekeeper comes to the STRTP to general clean. In addition, the staff helps clean the STRTP. During confidential interviews there was a noise coming from the toilet. It has since been repaired. A confidential interview disclosed the refrigerator in the garage is for overflow of food and drinks. It is locked to prevent staff from stealing food. Based on confidential interviews, there was not sufficient information to determine that the facility was not in clean, sanitary, and in good repair. Although the allegation may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegation, therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights given, and a copy of this report was reviewed and provided to LaCobra Curry, Administrative Assistant

Investigation Findings:
On June 28, 2023, at XXXX Licensing Program Analyst (LPA) Karen Beal arrived at All of God's Children's Group Home Short-Term Residential Therapeutic Program (STRTP) and with the facility Administrator XXXX to deliver the investigative finding for the above stated allegation involving the STRTP and the clients listed on the confidential names (LIC 811) dated April 14, 2023. On December 05, 2022, Community Care Licensing (CCL) received a complaint alleging the facility was not in clean, sanitary, and in good repair. On December 7, 2022, LPA Belinda Torres arrived at STRTP to initiate the complaint, conducted a health and safety inspection, and interviewed ADM. On December 13, 2022, LPA Torres recorded noise in the restroom. On April 13, 2023, LPA Beal arrived at STRTP and conducted two interviews (S2 and S3) and conducted a health and safety inspection there was immediate hazards observed. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 06/28/2023

met_with: La Cobra Curry


raw_content:
Narrative:
During the investigation, a confidential interview stated clients would get into physical altercations and staff did not intervene to stop the altercations. A confidential interview indicated that staff would say, "stop fighting" and did not stop the fights between clients. Another confidential interview reported being stabbed by a client in care because of a fight, however, confidential witnesses reported not observing marks on C1. Another confidential interview stated C1 was not stabbed by C2 or any other clients. LPA received inconsistent information regarding the allegations. Based on confidential interviews, the allegations that C1 sustained injuries while in care and C1 engaged in a physical altercation with C2 in care due to lack of supervision may have occurred, however, there are not supported or proven by evidence. Therefore, these allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report along with the appeal rights was provided to Administrative Assistant La'Cobra Curry.

Investigation Findings:
13On July 6, 2023, at 8:55AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with All of God's Children STRTP Administrative Assistant La'Cobra Curry to discuss the investigative findings for the above stated allegations involving clients and the facility staff. On July 14, 2022, at 3: PM, LPA B. Torres began the investigation at the facility. In addition, LPA A. Caballero conducted telephone interviews with Client #1 & Client #2(C1 &C2). Client #3 (C3) refused an interview. Client #4(C4) refused an interview. Additionally, LPA A. Caballero interviewed Staff #1(S1) and Staff #2(S2). Furthermore, LPA A. Caballero reviewed client and staff records. On July 6, 2022, Community Care Licensing received information alleging that client #1 (C1) sustained injuries while in care and that client #1(C1) engaged in a physical altercation with another client while in care. It was specified that C1 had puncture marks located on various parts of C1's body. One behind C1's left ear, right forearm, and in the center of C1's forehead. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Adaleyci Caballero 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 07/06/2023

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

met_with: Administrative Assistant-La'Cobra Curry


raw_content:
Narrative:
S1's use of marijuana and working at the facility while under the influence. Confidential interviews could not confirm or dispute S1 allowing children to smoke (marijuana) and/or drink alcohol while in the facilities care. Based on record review and confidential interviews the allegation alleging Staff (S1) allowed children to smoke (marijuana) and drink alcohol while in the facilities care, may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to All of God's Children Group Home, Facility Manager, Justin Asieru.

Investigation Findings:
13On September 15, 2023 at 3:15pm, Licensing Program Analyst (LPA), Nicole Strickland met with All of God's Children Group Home, Facility Manager, Justin Asieru to deliver the finding for the above stated allegation. The investigation was conducted by Special Investigator (SI) Georgina Tallagua and LPA N. Strickland and included interviews with four foster youth (Child #1 [C1], Child #2 [C2], Child #3 [C3], and Child #4 [C4]), eight staff (Staff #1 - Staff #8 [S1-S8]), and Director. In addition, county records and facility records were reviewed. On June 15, 2023, Community Care Licensing (CCL) received an allegation alleging Staff (S1) allowed children to smoke (marijuana) and drink alcohol while in the facilities care. Specifically, it was reported S1 brought marijuana to work on 6/9/2023 and has stated she allows residents to drink and smoke marijuana as long as they stay on property. Confidential interviews provided conflicting statements of UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 09/15/2023

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

met_with: Justin Asieru, Facility Manager


raw_content:
Narrative:
Confidential interviews also denied that any staff ever recorded nor took pictures of either client during this incident. While other confidential information received by CCL stated that these allegations had occurred. There were no other known witnesses to these allegations. Based on confidential information obtained during the course of this investigation, the allegations that clients engaged in inappropriate interaction due to a lack of care and supervision, and that staff recorded client's behavior on cell phone, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Child Counselor, Joanna Lanegan to discuss the investigative findings for the above stated allegations. Licensing Program Analysts (LPAs), Belinda Torres and Cynthia Urena conducted an inspection to the Short Term Residential Therapeutic Program (STRTP) on February 02, 2023, at 1:45pm and on July 27, 2023, at 2:00pm. No immediate hazards observed. LPAs Torres, Urena and Mena interviewed five staff (S1, S2, S3, S4 & S5), Facility Administrator (AD), two of two children involved (C1 & C2), County Social Worker (CSW), as well as reviewed client and facility records. Community Care Licensing (CCL) received information on January 24, 2023, alleging that clients engaged in inappropriate interaction due to a lack of care and supervision, and that staff recorded client's behavior on cell phone. Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. LPAs Torres, Urena and Mena obtained conflicting information during confidential interviews. Confidential interviews denied a lack of supervision and stated that it was staff who observed C1 and C2 laying on top of each other in bed underneath the covers, during a routine check and immediately intervened. According to confidential information, after this incident, supervision of C2 was increased and C2 was separated and placed in another bedroom to avoid any further incidents. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 12/11/2023

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

met_with: Joanna Lanegan


raw_content:
Narrative:
was C1 who argued with C2 and attempted to physically engage in an altercation with C2, before staff intervened. According to confidential interviews, there were never any physical altercations but only arguments between C1 and other clients. While other confidential Information received by the Licensing Office stated that these allegations had occurred, and that staff allowed Client #3 (C3) to intimidate and threaten C1 during arguments. There were no other known witnesses to these allegations. Based on interviews and confidential information obtained during the course of this investigation, the allegation that Facility Staff does not prevent clients from engaging in fights while in care, may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report and appeal rights were provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Administrative Assistant, Lacobra Curry to discuss the investigative findings for the above stated allegation. Licensing Program Analyst (LPA) Belinda Torres conducted an inspections of the Short Term Residential Therapeutic Program (STRTP) on February 16, 2023, at 2:38pm and no immediate hazards were observed. The investigation was jointly conducted by LPAs Torres, Cynthia Urena and Daniel Mena. The investigation included interviews with the Facility Administrative Assistant (AA), four staff (Staff #1 (S1), Staff #2 (S2), Staff #3 (S3) & Staff #4 (S4), four of four clients (Client #1 (C1), Client #2 (C2), Client #3 (C3) & Client # C4), County Social Worker (CSW), as well as a review of client and facility records. Community Care Licensing received information on February 13, 2023, alleging that Facility Staff does not prevent clients from engaging in fights while in care. Information obtained in confidential interviews did not corroborate the allegation with a preponderance of evidence. LPAs obtained conflicting information during interviews. Confidential interviews denied allegations that staff failed to intervene in physical altercation and arguments between Client # 1 (C1) and other clients in care. According to confidential information, it UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 02/14/2024

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

met_with: Lacobra Curry


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
***Continued from LIC 9099**** Regarding the allegation that staff are mishandling a minor's medication while in care, it was specifically alleged that STRTP staff would get medication from C1's school when the STRTP would run out of medication. It was stated in a confidential interview that S1 would get the medicine from the school when C1 leaves for a weekend visit or when the STRTP was not able to get a refill. A confidential interview stated that there were issues getting refills due to C1 medication changing often and the medication was not always available to be refilled. A confidential interview stated there were times when medication was missed due to the medication not being refilled. Documentation showed that the medication was supposed to be administered in the morning and the evening, but documentation reflects the medication was not administered as prescribed. There were multiple days on C1's PMR that showed discrepancies and there were days that medications were missed and not documented. Based on confidential interview and record review, the preponderance of evidence standard has been met, therefore, the allegation that staff are mishandling C1's medication while in care is substantiated. The STRTP is cited for violation of Interim Licensing Standards (ILS) Health Related Services (c) (see LIC 9099D). An exit interview was conducted and a copy of this report, LIC 811 (Confidential Names) and appeal rights were provided to Tami Robinson.

Investigation Findings:
13On February 15, 2024, at 4: PM licensing Program Analyst (LPA) Karen Beal arrived unannounced at All of God's Children's (STRTP) and met with Tami Robinson Facility Manager to deliver the finding for the above-stated allegation involving the client listed on the Confidential Names List, LIC 811, dated February 15, 2024. LPA Adaleyci Caballero inspected the STRTP, and no immediate health and safety hazards were observed. The investigation included interviews with the Administrator (ADM), clients (C1, C2, C3, C4 and C5), (ASW). LPA obtained copies of Placement Agreement, Psychotropic Medication Administration Record (MAR), Medication Management and Psychotropic Medication Record (PMR), Report of Medical/Dental Exam, and Needs and Service Plans for C1. LPA Beal attempted to contact the county social worker (CSW). On May 11, 2023, Community Care Licensing (CCL) received an allegation alleging staff are mishandling a minor's medication while in care. *** continued on LIC 9099-C*** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 02/15/2024

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

met_with: Tami Robinson, Facility Manager

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
The report further states that C1 physically assaulted S1, threw themselves on the ground, and demonstrated to staff (S1 and S2) how they (C1) can create marks on their (C1's) body. C1 then proceeded to use their hand and squeezed their right "wrist area," making "red marks" and a "handprint". LPA received pictures of C1 taken the day after the incident (04/05/2024) that showed red marks above C1's right wrist. In addition, multiple confidential interviews reported witnessing the incident and seeing C1 apply pressure to their right forearm, causing the injury. A Confidential witness statement also reported hearing C1 tell staff they (C1) knew how to hurt themselves. Likewise, other confidential interviews denied staff (S1, S2) restrained or harmed C1 and reported that C1 has a history of self-harm and making similar accusations when C1 does not get their way. LPA received conflicting information as C1 denied their injury was self-inflicted, and a confidential interview reported witnessing S1 grab C1 as alleged. Additionally, pertinent documentation also contained conflicting statements and reported that both S1 and S2 grabbed C1's arm, whereas other confidential interviews consistently reported that S1 and S2 did not cause injury to C1. Based on inconsistent confidential interviews and pertinent documentation, the allegation that staff (S1) handled minor(C1) roughly, causing bruising, is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to La Cobra Curry.

Investigation Findings:
13On June 21, 2024, at 1: PM, Licensing Program Analyst (LPA) Jessica Peete made an unannounced visit to All of God's Children Short Term Residential Therapeutic Program (STRTP) and met with Administrative Assistant, La Cobra Curry to deliver the investigative findings for the allegation mentioned above. LPA Peete completed interviews with the clients (C1-C6), STRTP staff (S1-S5) and the County Social Worker (CSW) On 04/10/2024, Community Care Licensing received a complaint alleging that staff (S1) handled minor(C1) roughly, causing bruising. Specifically, it was alleged that S1 grabbed C1's right forearm, causing visible bruising to the area. The Incident Report received by the department dated 04/04/2024 reported that C1 was involved in an aggressive act against staff (S1 and S2) and injured themselves. The report states that C1 became disruptive when they (C1) could not participate in another client's birthday. Continued on LIC 9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 06/21/2024

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

met_with: La Cobra Curry, Administrative Assistant


raw_content:
Narrative:
On 11/13/2023, Community Care Licensing (CCL) received a complaint that staff did not pick up a minor from the hospital in a timely manner, it was specially reported that the facility was contacted at around 3:30PM and as of 5:35PM the facility still had not called the hospital to arrange pickup for C1. Confidential interviews stated that C1 was on an authorized absence on the day C1 was admitted to the hospital and as a result, staff was not aware of C1's whereabouts until the facility received a call from the Sheriff's Department stating that C1 was at the hospital and needed to be picked up. Another confidential interview stated that S1 arrived at the hospital to pick up C1 approximately thirty minutes after receiving the phone call requesting C1 to be picked up. In addition, confidential interview disclosed that C1 was not discharged from hospital until approximately forty-five minutes after S1 arrived to the hospital. A confidential interview stated that S1 left the facility at approximately 8:00PM to pick up C1 from the hospital. LPA received conflicting information. Based on confidential interviews, the allegation that staff did not pick up C1 from hospital in a timely manner may have occurred, however, there is not a preponderance of evidence to support the alleged violation. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report LIC9099 and the appeal rights were discussed and provided to Administrator, Cheryl Jones.

Investigation Findings:
13On 09/12/2024, Licensing Program Analyst (LPA) Maya Chavez arrived at All of God's Children's Group Home Short-Term Residential Therapeutic Program (STRTP) and met with Administrtor Cheryl Jones to deliver the compliant finding to the allegation listed above. On 11/15/ LPA A. Caballero initiated the complaint and conducted a health and safety inspection, and no safety concerns were observed. During the course of the investigation, LPA A. Caballero conducted confidential interviews with Administrator (ADM) and LPA K. Beal interviewed staff 1 (S1) as well as conducted an additional interview with ADM. Furthermore, LPA M. Chavez conducted interviews with clients (C2 and C6-C9), ADM, and staff (S2 & S3). LPA's obtained copies of related Special Incident Reports (SIRs), the client roster and staff roster, and the placement agreements for C1 and C2. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Maya Chavez 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: ALL OF GOD'S CHILDREN'S GROUP HOMEFACILITY NUMBER: VISIT DATE: 09/12/2024

met_with: Administrtor- Cheryl Jones