raw_content:
Narrative:
It was alleged that staff members (S1, S3) made inappropriate comments while minors were present and encouraged the client (C1) to fight another client residing in the home. Staff (S1, S2, S3) denied the alleged allegations further indicating that all staff members are trauma-informed and understand the importance for each client to complete their individualized program. Staff further indicated that they have not heard nor have clients reported to them any incidents regarding staff using inappropriate language. All staff members denied encouraging anyone to fight, however, further disclosed that an incident occurred involving two clients (C1, C5) who were involved in a physical altercation outside of the facility. S1 further indicated that they were transporting C1 in the vehicle and received a call from another staff member (S2) informing them that C5 had just gone AWOL. S1 indicated that on the way back to the facility they observed C5 less than a block away from the facility, so they (S1) stopped to verbally redirect C5, and in doing so, C1 jumped out of the vehicle and started an altercation with C5. S1 indicated that she attempted to verbally redirect the clients but was not having any luck, so S1 called another staff member (S2) who assisted in separating the clients and taking them back to the facility without any further disruption. An incident report was completed, and all supporting agencies were notified in a timely manner. Information obtained from the above clients denied the alleged allegations further indicating the clients are the ones who threaten and use foul language toward staff when upset. Clients indicated that the staff does a good job of avoiding shouting matches and de-escalating situations that may arise in the facility between clients. Clients further stated that they feel safe and supported by the staff members at the facility. Clients denied that staff encourage them to fight each other. C1 further disclosed that she did get into an altercation outside the facility with a former client (C5). C1 indicated that they were being transported by S1 back to the facility and they had stopped to pick up C5 who had just gone AWOL. C1 stated that she got out of the car and started a verbal altercation with C5 which turned physical and was separated by S1 and S2. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Facility Administrator.

Investigation Findings:
13On October 21, 2022, at 10: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection of the above Short Term Therapeutic Program (STRTP) and met with the STRTP Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. On June 30, 2022, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff using profanity toward minors, and staff encouraging youth to fight other youth in care. The investigation of the above allegations was conducted by this LPA, and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with three staff members (S2, S3) on 8/4/22, S3 on 8/11/22, and four clients (C1, C2, C3, C4) on 8/4/22. (No statement was obtained from C5 due to them declining to be interviewed). (Reference Confidential Names Form LIC 811, dated October 21, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: James Penny House INC.FACILITY NUMBER: VISIT DATE: 10/21/2022

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

met_with: Destiny Tatum - Facility Manager


state: CA

facility_name: JAMES PENNY HOUSE INC.

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Page The investigation of the above allegation was conducted by LPA Winston Moroney, and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with three staff members (S1, S2, S3) on 10/21/22, four clients (C1, C2, C3, C4) on 10/28/22, and the CSW on 11/2/22. (Reference Confidential Names Form LIC 811, dated February 10, 2023). It was alleged that the facility staff handled a client (C4) in a rough manner while trying to redirect them resulting in staff pushing the client into a wall and hitting said client with an object. Information obtained from staff members (S1, S2, S3) denied the alleged allegations further indicating that all staff members are trauma informed and understand the importance of maintaining a healthy relationship with all clients and supporting them in successfully completing their individual programs. Facility staff further indicated that the facility is a hands-off facility and will only place hands on a client to prevent self-harm or bodily harm to others. Staff further disclosed that an incident involving (S3) and C4 occurred on 9/23/22 where (C4) had taken the cell phone into their room knowing that their CSW had informed staff that (C4) was not allowed to use their cellphone unless being supervised by a staff member. S4 indicated that supervision was required due to (C4) sending and receiving inappropriate messages from an unknown male. S3 indicated that when they attempted to retrieve the cell phone C4 ran into the room and began punching a hole in the wall, S4 attempted to verbally redirect and de-escalate the situation from the bedroom doorway when C4 ran and nudged S3 out of the way. S3 further disclosed that after two minutes of using verbal redirection C4 calmed down and proceeded to the living room where staff gave C4's phone back without further incident. Staff indicated that the incident was documented and sent to the appropriate agencies. Information obtained from CSW indicated that they were aware of the incident and when they spoke with C4, they didn't disclose any information indicating that everything was good and that they felt safe. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Facility Administrator.

Investigation Findings:
13On February 10, 2023, at 1: PM, Licensing Program Analyst (LPA) Christopher Larios conducted a complaint inspection of the above Facility on behalf of LPA Winston Moroney and met with Administrator Raeanna Howard. The purpose of the inspection was to deliver the findings for the above complaint allegations. On October 11, 2022, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff handled a minor in a rough manner while in care and Staff do not provide a safe environment for a minor in care. [Continued on Page 2] UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: James Penny House INC.FACILITY NUMBER: VISIT DATE: 02/10/2023

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

report_type: Complaint Investigation

met_with: Raeanna Howard

complaint_status: unsubstantiated


raw_content:
Narrative:
It was alleged that the staff did not report incidents to appropriate agency, staff did not accept the client back into the facility and facility did not follow the minor's treatment plan. The Ref. #1 (see Confidential Names, LIC Ref. #1 dated February 15, 2023) was placed at the facility on 6/30/22. CCL received Special Incident Report (SIR) dated 7/1/22 stating Ref. #1 attempted to AWOL on 7/1/22 at 5: PM and brought back to the facility by Law Enforcement (LE) on 7/2/22 at 12: AM. Ref. #1 became agitated and walked out of the facility stating they were leaving the facility. Ref. #1 picked up rocks from the flower bed and began throwing rocks at staff and facility's vehicles breaking windows. LE was called and when the Officer arrived, the Officer transported the Ref. #1 to Mark K Shell for 5150 hold. At 6: AM, the Officer called and informed a staff that Ref. #1 made threats to others in the facility so the LE Officer recommended that Ref. #1 not return to the facility. The facility received a call from the hospital requesting to pick Ref. #1 up as they will be discharged. The facility did not pick Ref. #1 up from the hospital because the Ref. #1's bed was closed. The facility contacted the placement county, Fresno Social Worker, regards to discharge of the client; due to immediate danger to staff and clients in the facility, the Ref. #1's bed was closed. The Ref. #1 was placed in the facility without the medication. The facility was informed the Ref. #1's medication will be brought to the facility next day, but the medication never came. Ref. #1's CSW stated that the emergency refill was requested. Staff stated the incidents are reported to appropriate agencies and CCL. Clients interviewed stated incidents are reported to their CSWs as they knew of the incidents. Based on the information gathered, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. A copy of this report, Confidential Names Form, and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On February 15, 2023, at 1: PM, Licensing Program Analyst (LPA), Karen Suh, conducted a follow-up complaint inspection to deliver the findings of an investigation concerning to the allegations above. The LPA met with the representative named above and discussed the findings. During the course of the investigation, LPA Elnora Smith interviewed four clients on 1/13/23 and 1/17/23, two staff on 1/13/23 and 1/19/23, Administrator on 1/18/23, reporting party on 1/19/23 and one County Social Worker on 1/30/23. The LPA was able to interview one client due to the client is placed at Fresno County Juvenile Hall and one client refused to be interviewed. LPA Karen Suh reviewed copies of documents: SIR dated 7/1/22, Ongoing Foster Placement Request, Health and Education Passport, JV- Order on Application for Psychotropic Medication, JV-220(A) Physician's Statement Attachment, Birth Certificate, IRPC Placement Recommendation, Admission Agreement, Intake Check List, Intake Facesheet, Treatment Recommendations, Need for Care, Nutritional & Physical Functioning Screening, Placement Information, Statement of Dangerous Behaviors, and Preplacement Appraisal Information. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: James Penny House INC.FACILITY NUMBER: VISIT DATE: 02/15/2023

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

met_with: Penny Brown, Unit Coordinator


facility_name: JOHN & DOROTHY ALMKLOV HOUSE

raw_content:
Narrative:
Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that an alleged violation occurred, therefore the allegation is unsubstantiated. There are no deficiencies to be cited regarding these allegations. A copy of this complaint with Ms. Smith.

Investigation Findings:
On September 1 2021, Licensing Program Analyst (LPA), Karen McGee,delivered the findings of the complaint investigation to Administrator, Trina Smith. On May 20, 2021, Monterey Park Children's Residential Program (MPCRP) received a complaint with the above mentioned allegations. The investigation included confidential interviews that consisted of, but were not limited to: the Administrator. The LPA reviewed the needs and services plans and special incident reports. The LPA observed client (see Confidential Names, LIC Ref. #1 dated September 1, 2021) medical history in the CWS/CMS System. The LPA did not receive return phone calls from the reporting party or county social worker. The LPA was unable to obtain the current contact information to interview Client Ref. #1. The investigation revealed that staff at the facility took Ref. #1 to the doctor and Ref. #1 tested negative for COVID19 on May 10, 2021. The investigation revealed that the information was shared with the client's teacher via email. Information in the CWS/CMS indicates that Ref. #1 was given a child wellness check on March 11, 2021. The LPA was unable to determine by the notes which indicated, "NKA" if Ref. #1 suffered allergies. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 09/01/2021

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

met_with: Trina Smith


raw_content:
Narrative:
It was alleged that a facility staff choked client. Facility staff and client denied the above allegation. It was also alleged that facility staff did not protect minor from other minors in the home. Facility staff and client denied the above allegation. Based on confidential interviews the facility staff did not choke client but did restrain client. Confidential interviews also revealed that facility staff are always present in the facility and interfere when clients get involved when there is a verbal or physical altercation between clients. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and appeal rights were provided to the facility representative.

Investigation Findings:
13On October 7, 2021 at 10: AM, Licensing Program Analyst (LPA) conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Martin met with the facility representative named above and discussed the findings. During the investigation, LPA Timika Martin conducted a record review on 09/00/21 and obtained copies of client's needs and services plan (NSP), special incident reports (SIRs) and ID & Emergency information for clients. LPA requested copies of the LIC 500 with staff contact information and client roster. Confidential interviews were conducted by LPA Martin with County Social Worker 1 (CSW1), County Social Worker 2 (CSW2) on 9/00/21; Client 1 (C1) and Administrator on 9/30/21 via telephone (See Confidential Names List Form LIC 811 dated October 7, 2021). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Timika Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 10/07/2021

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

met_with: Trina Smith, Administrator


raw_content:
Narrative:
It was alleged that staff pays residents to fight. Facility staff and client denied the above allegation. It was also alleged that staff do not provide adequate care and supervision. Facility staff and client denied the above allegation. Based on confidential interviews the facility staff does not pay residents to fight. Confidential interviews also revealed that facility staff are present in the facility to provide adequate care and supervision to clients in care. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and appeal rights were provided to the facility representative.

Investigation Findings:
13On December 27, 2021 at 1:00PM Licensing Program Analyst (LPA) Janeth Chavez conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Chavez met with the facility representative named above and discussed the findings. During the investigation, LPA Chavez conducted a record review on 11/08/21 and obtained copies of client's needs and services plan (NSP), special incident reports (SIRs) and ID & Emergency information for clients. LPA requested copies of the LIC 500 with staff contact information and client roster. Confidential interviews were conducted: County Social Worker 1 (CSW1) on 12/27/21; Client 1 & 2 (C1 & C2) and Administrator and Staff 1 on 11/08/21: Client 3, 4 & 5 refused to be interviewed; Staff 2, 3 & 4 on 11/17/21 (See Confidential Names List Form LIC 811 dated 11/08/21). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Janeth 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 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 12/27/2021

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

met_with: Ronnie Wofford


raw_content:
Narrative:
The LPA observed a Law Enforcement Contact Report dated March 28, 2022 reporting the incident that happened March 27, 2022. Ref. #3, the alleged victim, declined to provide information regarding the incident. So, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that an alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding this allegations. A copy of this complaint was provided to the facility representative.

Investigation Findings:
On August 4, 2022 at 3:30 p.m., Licensing Program Analyst (LPA), Karen McGee, met with Assistant Administrator, Trina Smith for the purpose of delivering the investigative findings. On March 28, 2022, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: two Facility Managers (FM) (see Confidential Names, LIC Ref. #1 and #2 dated August 4, 2022); and one Client, Ref. #3. Ref. #4 was not interviewed. The LPA reviewed the Needs and Services Plan and the Special Incident Report. The investigation revealed that Ref. #3 engaged in a fight with their roommate, Ref. #4, during the night shift. It revealed that FM #2 was on duty and became aware of the fight which happened within two minutes when Ref. #4 came from the bedroom breathing heavy. It revealed that FM#2 checked on Ref. #3 and questioned Ref. #3 and #4 about the fight. It revealed inconsisent information on why the fight began. It revealed that Ref. #3 was allowed to sleep in a different location in the facility that night. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 08/04/2022

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


raw_content:
Narrative:
The Department received a complaint alleging Client (C1) was restrained by Staff (S1). S1 denied the allegation. The investigation revealed S1 conducted a walk through of the facility grounds and observed a window open. S1 asked C1 to close the window. C1 became escalated, grabbed S1 and pulled S1 through the window. Statements obtained from interviews conducted with staff indicated a hold was used due to C1's aggressive behavior. The local police department was dispatched to the facility due to the incident and S1 declined to press charges. Information reported to the Department indicated C1 was not harmed during the incident. Based on information obtained from interviews conducted and record review the allegation is unsubstantiated. Although the allegation may have happened or is valid the standard of the preponderance of evidence was not met. Exit interview conducted and a copy of this report and Confidential Names List LIC811 dated 09/08/22 were given to the above mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13An unannounced follow up complaint inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 09/08/22 at 1: PM. During the inspection LPA Larios met with Lead Direct Care Staff (LDCS) Ronnie Wofford. The purpose of the inspection was to deliver findings on behalf of LPA Zeyda Loera regarding the above mentioned complaint allegation. During the course of the investigation LPA Loera conducted a record review at the facility on 02/22/22. LPA Loera obtained copies of the Staff Roster and contact information, Client Roster, Client's Needs and Services Plans (NSP) and Special Incident Reports (SIR). LPA Loera attempted to interview three clients (C1, C2, C3) on 02/22/22, however, all clients declined to provide a statement. In addition, LPA Loera conducted interviews with the facility Administrator (AD) and one Staff (S1) on 02/22/22 (See confidential names form LIC811 dated 09/08/22). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 09/08/2022

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Investigation revealed the following: It was alleged facility staff are not appropriately supervising minor in care. Interview conducted with staff were similar and denied the allegation. Staff stated that they have adequate staff throughout each shift to monitor the children in care. Staff stated that children get passes to walk or be in the community but that when children do not return on time or if they aren't allowed to be gone proper agencies are notified and local law enforcement is called, and reports are filed. Staff stated they typically are unaware of what transpires when children run away from facility. However, one staff stated that they were made aware of one incident occurring while one child was on runaway status due to local law enforcement telling them what happened, but staff stated they were not given specifics only questioned about potential locations of child's whereabouts. Children had similar statements and denied the allegation. Children stated that there are adequate staff and that there is adequate staff to meet their needs. Two children had contradictory statements. Children stated that there was adequate staff to supervise them in the home, but that staff don't always answer the phones when children are on outings or wanting to get picked up. Additionally, one child stated that staff don't intervene when children are fighting. However, the information provided for staff was unclear as to if incident occurred in the home or while children were outside on runaway or outing. Child in which this investigation was generated denied speaking with LPA. Documents reviewed identified proper notifications were made pertaining to incident referenced within this investigation and all incidents leading up to and after child returned were documented. Licensing Program Analyst attempted to reach county social worker but was unable to speak with county worker regarding incident but documents reviewed identified no issues or concerns with facility or children being placed in facility. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 9/13/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the John and Dorothy Almklov House for the purpose of concluding the above complaint investigation. LPA met with Lead Facility Manager and discussed the above identified findings. Investigation consisted of the following: On 6/7/ LPA interviewed Administrator and Direct Care staff (see confidential names, LIC 811, dated June 7, 2023). LPA received the following copies: Current staff/ client roster, staff training log, six (6) children's most recent needs and service plans, law enforcement special incident reports (SIRs) for the past two months and any associated complaints or documents associated to the care and supervision of children. On 6/21/ LPA met with and interviewed children (see confidential names LIC811 dated 6/21/2023). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 09/13/2023

met_with: Ronnie Wofford, Lead Facility Manager


raw_content:
Narrative:
LPA also reviewed pertinent STRTP records, Department databases, and reports from other agencies. Investigation revealed that STRTP staff took three (3) clients on a supervised walk around the neighborhood, satisfying the staff to client ratio for being outside of the facility. On the walk, the group came upon two additional STRTP clients at a local park who were out of the STRTP on permitted community pass. The two groups interacted and an argument ensued. STRTP staff attempted to de-escalate the argument throughout, getting between participants for separation, only for another to engage from a different angle. By all accounts of the clients involved, STRTP staff did actively supervise the youths and de-escalate to the best of his ability. Based on information gathered, 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. No deficiencies were cited during this inspection. Exit Interview conducted. A signed copy of this report, LIC9099-C, and LIC811 were provided to Henry Trochez, Administrator. Appeal rights provided.

Investigation Findings:
13On November 13, 2023, at 11:00 a.m., Licensing Program Analyst (LPA) John Bonilla arrived unannounced at the John & Dorothy Almklov House, a Short-term Residential Therapeutic Program (STRTP), and met with Henry Trochez, STRTP Administrator, for the purpose of delivering findings on the above complaint investigation. On September 26, 2023, the Department received a complaint alleging that the STRTP staff did not adequately supervise youths while in care. LPA's investigation consisted of the following: On 09/29/ LPA interviewed Reporting Party. On 10/05/ LPA interviewed two STRTP clients (see LIC Confidential Names list dated 10/5/23). LPA received the following copies: Current staff/ client roster, staff training log, clients' most recent Needs and Service Plans (NSPs), and relevant special incident reports (SIRs). On 10/19/ LPA interviewed two clients at their respective high school (see confidential names LIC811 dated 10/5/23). (Cont'd) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: John Bonilla LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 11/13/2023

met_with: Henry Trochez, Administrator


raw_content:
Narrative:
LPA also reviewed pertinent STRTP records, Department databases, and reports from other agencies. The STRTP has three bedrooms for clients. Two are along the left side of the home with the third bedroom, the master bedroom, being across a hallway that bisects the home. The facility has three restrooms in total. One is located within the master bedroom, one located in the hallway, and a third in the rear of the home, near staff offices. According to S1, The rear restroom is for staff only. Staff restroom has a toilet and sink and is used for multi-purpose storage. The hallway restroom is designated for use by the clients whose bedroom is on the left side of the home. The remaining restroom, in the master bedroom, is for the occupants of that bedroom. Interviews with S1, C1, C2, C4, and C5 were consistent in revealing that the restroom located in the master bedroom was being used by all clients as an auxiliary restroom if the hallway restroom was occupied. Based on LPA's observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Interim Licensing Standards Article 7 are being cited on the attached LIC9099-D. Exit Interview conducted. Plans of Correction discussed. A signed copy of this report, LIC9099-C, LIC9099-D, and LIC811 were provided to Henry Trochez, Administrator. Appeal rights provided. This is an amended finding delivered on 12/15/23. LPA also reviewed pertinent STRTP records, Department databases, and reports from other agencies. Interviews with clients (C1, C2, C4, C5) and staff (S1) returned answers inconsistent with the allegation of staff allowing youths to smoke in the facility. The STRTP has signs prominently posted stating that smoking/vaping is not allowed in the facility. Clients denied having seen anyone smoking or smelling smoke. Clients stated everyone was pretty much sober. Staff said they did not allow anyone to smoke in the home, and denied having smelled anything either. Staff did indicate that vape pens are seen on the client's person occasionally, but when seen, staff asks for the client to turn it in. In cases where a client did not surrender, then staff would allow them to go on, but wait for the client to leave the pen lying in plain sight or inside their laundry on laundry day to confiscate it. Based on the information gathered, 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. No deficiencies were cited during this inspection. Exit Interview conducted. A signed copy of this report, LIC9099-C, and LIC811 were provided to Henry Trochez, Administrator. Appeal rights provided.

Investigation Findings:
13On November 13, 2023, at 12:00 p.m., Licensing Program Analyst (LPA) John Bonilla arrived unannounced at the John & Dorothy Almklov House, a Short-Term Residential Therapeutic Program (STRTP), and met with Henry Trochez, STRTP Administrator, for the purpose of delivering findings on the above complaint investigation. On October 20, 2023, the Department received a complaint alleging that a client's bedroom is being used as a pathway to reach a facility restroom. LPA's investigation consisted of the following: On 10/19/ LPA interviewed Reporting Party. On 10/30/ LPA interviewed three STRTP clients (C2, C4, C5) and one facility staff (S1) (see LIC Confidential Names list dated 11/13/23). LPA received the following copies: Current staff/ client roster and facility floor plans. On 11/06/ LPA interviewed one client (C1), but was unable to meet with another (C3) at their respective high schools. (Cont'd) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: John Bonilla LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: JOHN & DOROTHY ALMKLOV HOUSEFACILITY NUMBER: VISIT DATE: 11/13/2023


facility_name: JOHNNIE'S HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Christopher Rollins conducted an annual Inspection with Johnnie's House. LPA met with Robert Oliver Administrator. Johnnie's House converted to Short Term Residential Therapeutic Program (STRTP) on June 30, 2020. STRTP is licensed to serve 6 clients ages 6-17. At 11: AM, LPA Rollins conducted a file review with Administrator. LPA reviewed 2 clients files and Staff files were reviewed. LPA observed two client files and found no deficiencies. The documentation in the clients file are complete. LPA observed all staff files to be complete, all correct documentation and all staff were up to date with there 40 hours of training for the year. LPA spoke with Administrator about the upcoming facility move to Oakhill Circle Oakland, California 94605. Administrator states that the move happen on June 10, 2021. LPA explain the documentation that the facility needs to turn in. LPA request an updated LIC 200, Fire Clearance, submit relocation checks to San Bruno Office and updated program statement with new address on it. Administrator states that currently the facility doesn't have any clients in the facility. LPA states that LPA will conduct a facility inspection when it is ready. LPA spoke with Administrator about facility getting there Mental Health Certification. Administrator states that facility is working with the county to get there Medi-Cal certification. LPA advised Administrator that LPA will extend the facility for another 6 months. During inspection, LPA requested a updated copy of the LIC Personnel Report to maintain their file current. A review of Licensing Information System on June 30, 2021 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. Per Title Regulations, no deficiencies were cited during this inspection. Exit interview conducted and a copy of the report was left at the facility.

report_type: Facility Evaluation

visit_type: Annual

met_with: Robert Oliver- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 09, 2022 at 3: PM Licensing Program Analysts (LPA's) Alyssa Ng and Isabel Mendoza conducted an unannounced case management inspection. The purpose of the inspection was to confirm that the above address ( Carrison St Berkeley, CA) is no longer operating as a Children's Residential Facility and has no children in placement. The house is a one story home in a residential neighborhood. There were no cars outside. In January of 2020 the facility sold their property. During inspection, it was confirmed that the above address is no longer a residential facility. Johnnies House is officially closed and the license forfeited.

visit_type: Case Management

met_with: New renters


facility_name: JORDAN HOUSE OF UMOJA

raw_content:
Investigation Findings:
13On 4/24/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint investigation visit. LPA met with Executive Assistant Betheny Jordan and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, the investigation found that the facility agreed to provide transportation to a medical appointment scheduled by the authorized representative, who holds medical rights. The facility was not provided sufficient notice of the initial appointment to arrange transportation. The day of the rescheduled appointment, the assigned staff member had a personal emergency and could not provide transportation. The appointment was rescheduled, and the resident has since been assessed. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, appeal rights provided, and a copy of this report left with Executive Assistant. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Executive Assistant Betheny Jordan


raw_content:
Investigation Findings:
13On 4/24/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint investigation visit. LPA met with Executive Assistant Betheny Jordan and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, the investigation found that the facility restricted family visitation and phone calls without the support of the full care team. Upon learning that an authorized representative did not agree with the new plan, the facility did not revise the plan. The plan of operation was then revised to support the revised visitation/call plan, including a statement that the licensee has deciding power to make such changes. The preponderance of evidence standard has been met, and therefore the above allegations is found to be substantiated. LPA is issuing citations of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section Personal Rights. An exit interview was conducted, appeal rights provided, and a copy of this report left with Executive Assistant Betheny Jordan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: JORDAN HOUSE OF UMOJAFACILITY NUMBER: 075650172


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. 1 deficiency citation was issued at today's visit. See attached deficiency page. A plan of correction for the deficiency was developed in consultation with an authorized facility representative. LPA conducted an exit interview and reviewed this report and attachments with Administrator. Copies of this report, attachments, and appeal rights were provided at the end of the visit.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Administrator George Jordan, Facility Manager Nathan Austin

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Additionally, it was found that not all staff were ensuring they had a resident's rescue inhaler during transport, due to not bringing it in the vehicle and not being able to locate it in the vehicle. Administrator and staff confirmed that the inhaler was stored in the console of the vehicle. Staff were ensuring they had the inhaler during afternoon activities but not during morning transport to school, which is located about 40 minutes away from the facility. 2 deficiency citations were issued at today's visit. See attached deficiency page. A plan of correction for each deficiency was developed in consultation with an authorized facility representative. LPA conducted an exit interview and reviewed this report and attachments with Facility Manager. Copies of this report, attachments, and appeal rights were provided at the end of the visit.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Administrator George Jordan; Facility Manager Nathan Austin


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

met_with: Malik Petri


summary: Complaint Investigation - Substantiated

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


summary: Complaint Investigation - Substantiated

met_with: Supervising Facility Manager Lanesha Morris

investigation_findings: SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


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

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

met_with: Facility Manager, Lanesha Morris


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 28, 2026 at 10:45am, Licensing Program Analyst (LPA) Celeste Aparicio conducted an unannounced visit to the facility and met with Direct Lead Youth Mentor, Lamica Tevis and Program Director, Pertrina Moreau. The purpose of the visit was to conduct a case management inspection regarding the facility's procedures for enrolling youth in school upon admission. At the time of the inspection, there were no clients and one (1) staff present. Based on a review of facility records and staff interviews, it was determined that upon admission the facility did not review a youth's Individualized Education Program (IEP) or contact the youth's school of origin prior to enrolling the youth in the local school district. When the facility later contacted the school of origin, it was confirmed that the school-located approximately 45 minutes from the facility-was unable to provide transportation. The facility then proceeded to enroll the youth in the local school district rather than arranging transportation, as required by the facility's Plan of Operation, which states that the facility is responsible for transporting youth to their school. Following enrollment in the local school district, the district experienced delays in identifying an appropriate placement that could meet the youth's IEP requirements. As a result, the youth did not attend school for approximately three months. [report continued on LIC809-C] Based on these findings, the LPA is issuing a citation for violations of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5: Section 87072(c)(35) Personal Rights, and Section 87074(c)(2) Transportation. Additionally, a technical violation is being issued for Section 87072(c) Personal Rights, and Section 87022(f) Plan of Operation (see attached LIC 809-D and LIC 9102). An exit interview was conducted with the Program Director, and a copy of this report was provided to the facility.

Deficiencies:
87074: (2) School, including to the child's school of origin.

met_with: Direct Lead, Lamica Tevis and Program Director, Pertrina Moreau

title: Transportation (c) Unless other arrangements are specified in the needs and services plan ... for a child... a licensee shall ensure transportation is provided to the following


summary: Facility Evaluation

raw_content:
Narrative:
On May 5, 2026 at 10:25am, Licensing Program Analyst (LPA) Celeste Aparicio made an announced collateral visit to the facility to conduct a confidential interview. LPA met with Direct Lead, Lamica Tevis and informed them on the purpose of the visit. LPA attempted to conduct a confidential interview related to an external investigation; however, the individual declined to participate. An exit interview was conducted, and a copy of this report was left with Direct Lead.

met_with: Direct Lead, Lamica Tevis


facility_name: JOY HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On October 30, Licensing Program Analyst (LPA) Shikya Belfield met with Facility Administrator, Anjelle Skates for a pre-licensing inspection at the above facility. LPA discussed the following with Anjelle Skates: Forms that the facility uses and require updates. LPA observed LIC610C which needs to have updates made. LPA discussed roles and designation of responsibilities when administrator is absent- policies or procedures that was submitted with the application and discussed with LPA Monica Pavia during a pre-licensing inspection in June, the facility is changing location to this facility. 1. Facility grounds were inspected. There are three additional structures on facility grounds. Joy House will be utilized as the residential house for the Short-Term Residential Therapeutic Program (STRTP) license, capacity of 6. All buildings/structures on facility grounds, will be kept locked. Grounds are clean and free from observable hazards. The facility does not have a swimming pool or any bodies of water. Firearms are not allowed on facility premises. 2. Adequate indoor activity space was observed by LPA Belfield. Large outdoor activity space was observed By LPA Belfield.. 3. Storage for Chemicals and sharp objects such as knives, were observed and had appropriate locks.. 4. Procedures for Locked and centrally stored medications observed as well as a locked cabinet. 6. Adequate storage space observed in the facility. 7. Current activity schedule observed in the main hallway and living room. 8. Currently there are no activities supplies observed. 9. First aid kit observed. 10. Individual beds in good repair observed. A supply of extra linens available for bed changes. 11. Joy house has three client bedrooms, double occupancy and 3 client bathrooms. Bedrooms are accommodating of all required furnishings. 12. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 13. Sample menu posted. 14. All appropriate forms posted within client view. 15. Dining room equipped with large table and chairs accommodating of all clients. 16. Hot water measured within the required temperature range 17. Fire place observed with cover however there is no locking mechanism to make inaccessible. Licensee agrees to place a lock over the fire place cover. Applicant and administrator are cleared through guardian and all staff hired will be criminally record cleared before being allowed to be in the facility. Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day, either verbal or written. A full report is to be remitted within 7 days via email to SBIRCR@dss.ca.gov. Also discussed was any changes made to the administrative organization must be submitted to the department in writing within 10 days. All applications require a secondary review from a Licensing Program Manager (LPM). Once reviewed and approved by LPM, this STRTP facility will be ready for licensure. Licensee will complete component three of the licensing process before license is issued. All necessary changes needed will be sent to the department by the end of business on November 6, 2024. A copy of this report was left with Administrator Anjelle Skates.

met_with: Anjelle Skates


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield and LPA Benjiman Oliver, conducted an unannounced inspection on 2/10/25 at 1: PM, and met with Program Coordinator Colleen Congress. Also present during this inspection were one staff and one clinician. The facility is licensed for a capacity of 6 ambulatory children, ages 12 -17. There are currently 1 client residing in the facility who was present during the time of this inspection. The CARE TOOL was used during this inspection. During this inspection LPA attempted to conduct an interview with client and was not successful. Due to time restrictions, the inspection could not be complete at this time. There were no violations cited during this inspection. An exit interview was conducted and copy of this report was left with Colleen Congress.

met_with: Colleen Congress


summary: Facility Evaluation

raw_content:
Narrative:
On 2-20-25 1:30PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Joy Hose, and met with Administrator Anjelle Skates, who helped with the inspection. The purpose of the inspection was to interview a client that may have witnessed an incident at their former placement. The client refused to interview. The facility was clean and in good order. An exit interview conducted and a copy of this report was given to Anjelle Skates, Administrator.

met_with: Anjelle Skates, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced inspection on 1/30/25 at 1: PM, and met with Administrator, Anjelle Skates. Also present during this inspection were one case manager, two staff, and one clinician. The facility is licensed for a capacity of 6 ambulatory children, ages 12 -17. There are currently 2 clients residing in the facility and only one client present during the time of this inspection. The CARE TOOL was used during this inspection. During this inspection, the entire facility was toured. The facility and grounds are in good repair, and free of obstructions. There is adequate indoor activity space and materials. Chemicals are stored in a locked cabinet. Locked and centrally stored medications observed. Adequate storage space observed. Individual beds are in good repair, clean mattresses and pillows observed. Bedrooms are accommodating of all required furnishings. Adequate food storage space observed. Supply of two days of perishable foods and nonperishable foods observed upon inspection. Weekly menu is posted in the kitchen. LPA Belfield reviewed one client file and no staff files. LPA conducted one client interview with C1 ( see lic811 dated 1/30/2025). All current residents were placed within the last 2 weeks. Fingerprint clearances were reviewed using Guardian on 1/30/2025. Based on a review of the facility roster printed on 1/30/25 and discussion with program administrator, one staff (S1) (See lic811 dated 1/30/2025), S1 is not criminally record cleared to work in this facility and they have worked at least five days in the last two weeks. Facility is being cited for violation of California Code of Regulations, Title 22, Divsion Six, Section 80019(e)(2) Criminal Record Clearance as described on the following page LIC9099D Civil penalty will be assessed. At this time the inspection is incomplete and will be completed at a later date. An exit interview was conducted and a copy of this report along with appeal rights were left with administrator Anjelle Skates.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield and LPA Omar Sawyer, conducted an unannounced inspection on 4/25/25 at 11: AM, and met with youth advocate (staff) Irinea Duenas. Also present during this inspection were one client. The facility is licensed for a capacity of 6 ambulatory children, ages 12 -17. There is currently one client residing in the facility who was present during the time of this inspection. The CARE TOOL was used during this inspection. Licensee Helen Ayala arrived at the facility with Program Director Annahi Ruano, who continued the inspection with these LPA's. LPA's attempted to conduct an interview with the client however, the client declined to speak to these LPA's. LPA's conducted a walk through of the facility with staff and reviewed six staff files and three client files. Based on a review of staff files, six out of six files were missing information. Although staff received some training, they did not meet the requirements outlined in the regulations regarding CPR training and required training topics. Based on a review of client files, signed forms for policies and procedures were not present. Facility was cited for violation of California Code of Regulations Title Division Six or Interim Licensing Standards were during this inspection. Technical Advisories were issued regarding staff training. A review of the guardian system shows that all staff are criminally record cleared to work in the facility. An exit interview was conducted a copy of this report along with appeal rights was left with Licensee Helen Ayala.

met_with: Helen Ayala


summary: Facility Evaluation

raw_content:
Narrative:
On 08/28/2025 at 11:15 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Anjelle Skates, Administrator. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. LPA Rodriguez used the CARE Inspection Tool. The facility currently has a census of two (2) clients. LPA Rodriguez reviewed five (5) staff files, two (2) client files, and the emergency disaster plan binder. LPA Rodriguez conducted two (2) confidential staff interviews and two (2) attempted confidential client interviews. The clients did not want to get interviewed. During physical plant inspection, no deficiencies were found. LPA Rodriguez toured the facility inside and out. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and full-sized beds. Each bedroom has drawers for extra storage space. The client's bathroom was clean and furnished with hygiene supplies for each client. Extra linens are in a closet in the hallway. The facility is clean, safe, and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. The weekly menu was posted. No bodies of water on the premises. All walkways were free from debris or hazards. LPA toured the backyard and observed it to be free from hazards. At this time, the inspection is not complete. LPA Rodriguez will be back at a later day to complete the required annual inspection. An exit interview was conducted at 1:58 p.m., and a copy of this report was given to Administrator Anjelle Skates, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/17/2025 at 1:00 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Anjelle Skates, Administrator. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. The purpose of this visit was to complete the required Annual Inspection. LPA Rodriguez used the CARE Inspection Tool. The facility currently has a census of three (3) clients. LPA Rodriguez reviewed the Emergency Response Plan binder and training certificates staff has done and received. The required Annual Inspection is complete. No deficiencies were cited. An exit interview was conducted at 2:07 p.m., and a copy of this report was printed and given to Administrator Anjelle Skates, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/17/2025 at 1:00 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez met with Anjelle Skates, Administrator, regarding an incident report that was reported to CCL on 09/09/2025. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 09/09/2025. More information on Incident Report on LIC 812. LPA Rodriguez conducted one (1) confidential staff interview. An exit interview was conducted at 2:09 p.m., and a copy of this report was printed and given to Administrator Anjelle Skates, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia scheduled a Technical Assistance (TA) meeting on above date and time. Attendees to the meeting were: Monica Pavia, Carolyn Flynn, Marjana Jackson, Levi Huser, Helen Ayala and Amanda Tucker. Items discussed: 1. Plan of Operation/Program Statement to be formatted according to STRTP Interim Licensing Standards, version 4. (Review tool received for section titles.) 2. There are no questions on the notes provided, at this time. 3. Any questions will be directed to LPA Monica Pavia. The goal is to resubmit the Plan of Operation/Program Statement by Friday, October 13, 2023.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia scheduled a Technical Assistance (TA) meeting, via Teams, on above date and time. Attendees to the meeting were: Monica Pavia, Carolyn Flynn, Marjana Jackson, Levi Huser, Isabella Karabed. Items discussed: 1. Plan of Operation/Program Statement to be formatted according to STRTP Interim Licensing Standards, version 4. (Review tool received for section titles.) 2. Plan of Operation: Section G - Admission Determination Procedures. Elevated review procedures were explained. 3. Plan of Operation: Section Q - Continuous Quality Improvement (CQI). Expand age appropriate feedback and include a sample of questions for clients in placement. 4. Program Statement: Core Services and Support. Additional trauma informed practices and disengagement skills to be used by staff. CPI training will be submitted as an appendix to this section. All incidents (on or off site) will be documented and reported, to Community Care Licensing (CCL), on an Unusual Incident/Injury Report (LIC624) or Law Enforcement Contract Report (LIC624-LE). 5. Any questions will be directed to LPA Monica Pavia. The estimated re-submission of the Plan of Operation/Program Statement is Friday, October 20, 2023.

met_with: Isabella Karabed, Program Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Monica Pavia and Jasmine Cardeno made an announced site inspection, for the purpose of preparing for a prelicensing inspection, at a later date. LPAs met with Facility Manager, Anjelle Skates, who provided a tour of all buildings on the campus. LPAs observed the following items that need to be addressed prior to a prelicensing inspection to be scheduled. 1. Capacity request for Short-Term Residential Therapeutic Program (STRTP) application must not exceed bedroom space available for children in placement. No more than 2 children shall share a bedroom. 87087(b)(1) 2. Program shall not have more beds for children's use than required for the maximum capacity approved by the licensing agency. 87088(c)(1)(A) 3. LPA will check camera policy with CCL policy department. Cameras are never allowed to be used in lieu of staff supervision. 87078(b) 4. Bunk beds are not allowed for this population. 87088(c)(1)(C) 4. Hot water temperature shall be maintained between 105 and 120 degrees Fahrenheit. 80088(e)(1) 6. All sharps and poisonous cleaning supplies must be kept locked. 80087(g)(1) 7. Dining room must provide necessary space for licensed capacity. 87087.3(a) 8. Extra linens to be made available in children's living quarters. 80088(g) 9. All food must be covered in the refrigerator/freezer. 10. Display Personal Rights, Menus and Complaint Policy/Grievance Forms in each building on campus, accessed by children in placement.


summary: Facility Evaluation

raw_content:
Narrative:
On June 3, Licensing Program Analyst (LPA) Monica Pavia met with Facility Manager/Administrator, Anjelle Skates for a prelicensing inspection. LPA discussed the following with Anjelle Skates: Forms that the facility uses and will continue to use. Corporate organization - Including chain of command and roles of staff Written plans, policies or procedures that was submitted with the application. Administrator qualifications and duties. 1. Facility grounds were inspected. There are several structures on facility grounds. Joy House will be utilized as the residential house for the Short-Term Residential Therapeutic Program (STRTP) license, capacity of 8. (Capacity on this report will be updated.) All buildings/structures on facility grounds, not in use, will be kept locked. Grounds are clean and free from observable hazard. The facility does not have a swimming pool or any bodies of water. Firearms are not allowed on facility premises. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked. 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. Joy house has 4 client bedrooms, double occupancy and 2 client bathrooms. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of all clients. 13. Hot water measured 109.4 degrees on this date. Applicant and staff are associated through Guardian and have been fingerprint cleared. Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day, either verbal or written. A full report is to be remitted within 7 days via email to SBIRCR@dss.ca.gov. All applications require a secondary review from a Licensing Program Manager (LPM). Once reviewed and approved by LPM, this STRTP facility will be ready for licensure. A copy of this report was emailed to Anjelle Skates.

visit_type: Prelicensing


facility_name: JR'S NORTH STAR II

summary: Facility Evaluation

raw_content:
Narrative:
On 6/16/2021 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield initiated an annual /required inspection at the above facility. Upon entering the facility LPA Belfield was greeted by administrator Tangie Jackson and Jamie Richard who assisted with the inspection. Present during this inspection were three staff and two clients. A tour of the facility was conducted, observed during the time of the inspection were the following; posted forms: all forms required to be posted such as license, personal rights, facility sketch, meal menu, and activity calendar, were all posted. Smoke detectors were located and are in working condition. The facility was observed to be clean and in good repair. Food supply was sufficient for non-perishable food and perishable food for one week. LPA interviewed C1 and C2 ( see LIC 811 dated 6/16/2021). The water temperature was below 120 degrees which is within the requirements of the regulations. During this inspection LPA Belfield reviewed staff files and client files. During a file review it was observed in the Licensing information System that they were no active fingerprints for S2 ( see Lic 811 dated 6/16/2021) however, LPA Belfield observed paper work showing an approved exemption status from the department. At this time it is unclear what happened to cause a conflict of information in the system. LPA discussed with administrator Jackson, that S2 needed to stop working until the issue with their finger prints were resolved. LPA observed all client and staff records to be up to date and complete. LPA Belfield discussed medication logs with administrator Jackson and reminded administrator that Psychotropic medications must be documented separately. All medication logs are current and complete. LPA observed medications remaining. Also discussed were the use of medication forms. LPA informed administrator Jackson that the program could create their own forms to log medication as long as it has all of the required information according to the regulations. Advisory issued for section, 80070(a) client records. During a client file review it was observed by this LPA that C4 did not have an immunization record. This was due to the client being recently placed and files were being obtained by the county worker as stated by administrator Jackson. LPA Belfield conducted interviews with C4 and C5 who were present in the facility. Advisory issued for of California Code of Regulations, Title 22, Division Six, section 80070(a) Client Records. There were no violations of California Code of Regulations, Title 22, Division Six or Interim Licensing Standards, cited during this inspection. An exit interview was conducted with administrator Jackson and a copy of this report will be sent to Licensee Jamie Richard and administrator Jackson.

met_with: Tangie Jackson


summary: Facility Evaluation

raw_content:
Narrative:
On Friday May 13, 2022 at 11: AM Regional Manager, Nelson Martinez, Licensing Program Managers (LPM's) Carolyn Flynn, Helga Wong and Isabel Mendoza conducted an office meeting virtually via Microsoft Teams. Community Care Licensing (CCL) met JR Northstar I Administrator, Rachel McCormick and Consultant, Tricca Leverenz. Tandreya Jackson was unable to attend. The purpose of this meeting was to discuss the Mental Health Program Approval (MHPA) and the required items for permanent licensure for JR Northstar I & II. The facility's 24 month STRTP provisional expires on June 30, 2022. The facility submitted their MHPA to DHCS on April 12, 2022. DHCS cannot move forward with the application until the facility finds a qualified Head of Service and the facility is contracted by Contra Costa County Behavioral Health. At this time, the county is expected to finish their review by August of 2022. During this meeting the following options were discussed; withdrawal of STRTP application by the program, this would prevent CCL (Community Care Licensing) from taking legal action against the program. The facility was informed that if the program is not able to obtain their Mental Health approval by the date of June 30, 2022 the department will have to take legal action. The facility was also informed that they could withdraw their STRTP application and submit a plan of closure. The facility will have an internal discussion, and the Administrator, Rachel McCormick will contact LPM Mendoza on when they will submit their closure plan to CCL, or notify LPM if there are any immediate changes with DHCS or their county contract. A copy of this report was emailed to the facility for signature.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 08/10/22 at 9: AM Licensing Program Analysts (LPA's) Alyssa Ng and George Karkazis conducted an unannounced case management inspection. The purpose of the inspection was to confirm that the above address ( Page Court, Pinole, CA) is no longer operating as a Children's Residential Facility and has no children in placement. The house is a two story home in a residential neighborhood. Assistant Executive Director Rachael was present and had construction staff remodeling the house. During inspection, it was confirmed that the above address is no longer a residential facility. Assistant Executive Director Rachael also gave me their license. JR's North Star II is officially closed and the license forfeited.

met_with: Rachael McCormick


facility_name: JR'S NORTH STAR, INCORPORATED

summary: Facility Evaluation

raw_content:
Narrative:
At 11:10am, Licensing Program Analyst (LPA) made an announced inspection to interview a client in placement for a complaint investigation. LPA met with Jamie Richard, Staff, who helped facilitate the inspection. At 11:15am, LPA interviewed Client 1 (C1) on the outside porch of the facility. An exit interview was conducted and a copy of this report was emailed to staff. .

met_with: Jamie Richard


summary: Facility Evaluation

raw_content:
Narrative:
On 6/16/2021 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield initiated an annual /required inspection at the above facility. Upon entering the facility LPA Belfield was greeted by Licensee Jamie Richard who assisted with the inspection. Present during this inspection were one staff and three clients. A tour of the facility was conducted, observed during the time of the inspection were the following; posted forms: all forms required to be posted such as license, personal rights, facility emergency evacuation plan, and meal menu, were all posted. Also posted were most recent fire clearances and recently purchased fire extinguishers. Smoke detectors were located in each client bedroom as well as the main area of the facility and are in working condition. The facility was observed to be clean and in good repair. Food supply was sufficient for non-perishable food and perishable food for one week. Due to the facility being affected by the pandemic, Licensee states they grocery shopping is completed twice a week and that the program now utilizes a grocery delivery service to assist. Due to the recent accreditation process that the program had completed, the facility's client and staff files were temporary relocated at the second location. LPA Belfield will review the files at that location. Medication logs and location were in a locked file cabinet. Client's rooms were clean and all bedding had proper linen. One client's bed was observed to have the box spring off the rails, however this was adjusted during the inspection. LPA observed client files for the three clients that are currently placed in the facility, C1, C2, and, C3 ( see LIC 811 dated 6/16/21). C1 and C2 allowed this LPA to look in their room briefly and did not want this LPA to see their closet. C3 did not want this LPA to look in their room at all, however they changed their minds and asked this LPA to observe. All client's rooms were clean and in good repair. No violations of California Code of Regulations, Title 22, Division Six, or Interim Licensing Standards were cited during this inspection. An exit interview was conducted with Licensee and a copy of this report will be sent to Licensee Jamie Richard.


summary: Facility Evaluation

raw_content:
Narrative:
On Friday May 13, 2022 at 11: AM Regional Manager, Nelson Martinez, Licensing Program Managers (LPM's) Carolyn Flynn, Helga Wong and Isabel Mendoza conducted an office meeting virtually via Microsoft Teams. Community Care Licensing (CCL) met with Administrator, Rachel McCormick and Consultant, Tricca Leverenz. The purpose of this meeting was to discuss the Mental Health Program Approval (MHPA) and the required items for permanent licensure for JR Northstar I & II. The facility's 24 month STRTP provisional expires on June 30, 2022. The facility submitted their MHPA to DHCS on April 12, 2022. DHCS cannot move forward with the application until the facility finds a qualified Head of Service and the facility is contracted by Contra Costa County Behavioral Health. At this time, the county is expected to finish their review by August of 2022. During this meeting the following options were discussed; withdrawal of STRTP application by the program, this would prevent CCL (Community Care Licensing) from taking legal action against the program. The facility was informed that if the program is not able to obtain their Mental Health approval by the date of June 30, 2022 the department will have to take legal action. The facility was also informed that they could withdraw their STRTP application and submit a plan of closure. The facility will have an internal discussion, and the Administrator, Rachel McCormick will contact LPM Mendoza on when they will submit their closure plan to CCL, or notify LPM if there are any immediate changes with DHCS or their county contract. A copy of this report was emailed to the facility for signature.

met_with: Rachel McCormick


summary: Facility Evaluation

raw_content:
Narrative:
On 8/22/22 at 10: AM, Licensing Program Analysts George Karkazis and Alyssa Ng conducted an unannounced Annual/Random at listed facility. LPA's met with Jamie Richard, Executive Director(ED) and toured the facility inside and out. The group home is currently licensed to serve 6 clients, currently there are four clients. Present during the inspection were three staff and three clients. At 10:50am, LPA's toured the facility. LPA saw three bedrooms and three bathrooms. Two bathrooms were for clients and one was for staff. LPA's observed the facility license, personal rights, facility sketch, facility rules, and other forms posted[ on the walls throughout the facility. LPA Karkazis interviewed one client and two staff. LPA Karkazis and Ng reviewed staff and client files. The needs and services plans were not up to date. The facility menu was not posted in the kitchen. LPA's advised ED to have the facility menu posted. All staff were fingerprinted and had child abuse index check clearances. LPA Karkazis tested the water temperature and found it to be 114 degrees, which is in within range. Thermostat read 68 degrees, within range. At 11:00am LPA's walked through the backyard. There were no open bodies of water. LPA's observed a pile of miscellaneous tools, cardboard, lawn furniture, and debris. ED explained that the house was under construction and that some of the debris was from the closure of their other facility. LPA's advised ED to have the pile removed and cleaned. There were 2 days of perishable foods and 7 days of non-perishable foods present. Sharps and chemicals were located in a locked staff closet. The medication was also stored away in a locked staff closet. Facility cited for Interim Licensing Standards, Title 22, Division 6, regulation 87070(b)(18). See attached 809-D. At this time, there were one deficiency, one technical violation, and one technical advisory during this inspection. An exit interview was conducted, appeal rights discussed, and a copy of this report was left at this facility, with Rachael McCormick, director.

met_with: Jammie Richard


summary: Facility Evaluation

raw_content:
Narrative:
On 2/2/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility to confirm closure. LPA called and spoke to Assistant Executive Director Rachael McCormick during visit. There was no one present and no response to the doorbell. Asst. Executive Director confirmed that the facility was closed and the house was empty and that the paper license will be sent to LPA. An exit interview was conducted, and a copy of this report provided to Asst. Executive Director, who agreed to receive a copy and return to LPA signed.

met_with: Asst. Executive Director Rachael McCormick


facility_name: KIDS TO KIDS- FAITH HOUSE

raw_content:
Narrative:
Although there is evidence indicating implementation of established AWOL policy and staff intervention, neglectful behavior and/or lack of resident oversight cannot be confirmed with C1 due to unknown whereabouts and lack of impartial witnesses. Therefore, it must be concluded that an allegation of neglect/lack of supervision cannot be substantiated at this time. There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On June 30 2022 at , Licensing Program Analyst (LPA) Kuliema Calloway and Licensing Program Manager (LPM), Kevin Sauk made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA spoke with Facllity Administrator (FA) and together, discussed the investigative findings. [See confidential names form LIC 811 dated 6/30/2022). During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Based on the interviews conducted and documents obtained, the above allegation is found to be Unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Supporting evidence includes: unsuccessful attempts to locate and interview victim due to multiple changes in placements, review of facility AWOL policy, consistent staff reports demonstrating understanding of AWOL policy, and review of fifteen SIRs reporting C1s AWOLs along with staff attempts to intervene. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Kuliema Calloway LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: KIDS TO KIDS- FAITH HOUSEFACILITY NUMBER: VISIT DATE: 06/30/2022

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

met_with: David Yasutake, Administrator


raw_content:
Narrative:
On 03/08/2021 at approximately 6:00, Client#1 (C1) runway way (AWOL) from the facility. Facility staff attempted to redirect C1 and was offered to go on a walk, do activities, and have a one-on-one with staff. Facility had the Crisis Team on call with C1. C1 hang up on the Crisis Team but at approximately at 7:30pm, C AWOL from the facility. Facility contacted Ventura County Police Department to report missing person report. C1 was gone for approximately two hours. At around 9:45pm, C1 reached out to Facility Staff to report that she left to the Vons shopping center near the facility and that she was in a car on unknown man. Facility staff and Law Enforcement arrived the Vons shopping center to pick up C1. Facility reported that C1 was outside of the man's car and was trying to get back in. C1 and unknown man reported a different description of the incident. C1 was offer medical assistance and was given counsel that was not able to determine if the incident did happen. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Neglect and Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On July 28, 2022, at 09:30am, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to Kids to Kids- Faith House Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated June 28, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas determined that Neglect/Lack of Supervision allegation that facility staff did not prevent a minor from running away (AWOL), may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues on LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: KIDS TO KIDS- FAITH HOUSEFACILITY NUMBER: VISIT DATE: 07/28/2022

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

met_with: Facility Manager


raw_content:
Narrative:
On 03/12/2021 at approximately 4:20pm, Client#1 (C1) runaway (AWOL) from the facility. Staff#2 (S2) offer a one-on-one walk around the neighborhood. During the walk C1 separated herself from S2. S2 followed until C2 was able to get out of eyesight. Facility contacted Ventura County Police Department to report missing person report. Facility staff reported, that C1 was habitual AWOLer. Facility staff described how they try to redirect clients from running away by offering to go on a walk, do activities, and adding extra supervision. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Neglect and Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On July 28, 2022, at 09:30am, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to Kids to Kids- Faith House Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated June 28, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas determined that Neglect/Lack of Supervision allegation that facility did not adequately supervise group home child, may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: KIDS TO KIDS- FAITH HOUSEFACILITY NUMBER: VISIT DATE: 07/28/2022

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

met_with: Staff#1 (S1)


raw_content:
Investigation Findings:
13On September 20, 2022, at 10:30 a.m., Licensing Program Analyst (LPA), Kuliema Calloway, made an unannounced visit to the above facility for the purpose of concluding complaint findings. LPA met with Daniel Bakst, Head of Service at Kids to Kids Faith House who granted access. Based on the interviews with three out of six clients and three staff, the investigation revealed conflicting states, where it is unclear whether staff (S1) handled the client (C2) in a rough matter. [See LIC 811, dated 9/20/2022]. Based on review and analyzing all evidence, the LPA has found this complaint to be Unsubstantiated, meaning the allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. There are no deficiencies to be cited for this allegation. A copy of this report and appeal rights were provided to Daniel Bakst at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Kuliema Calloway LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Daniel Bakst, Head of Service


raw_content:
Narrative:
continued from page 1 (LIC 9099) On November 11th, AGPA Woodard conducted a subsequent inspection to the facility for the purpose of gathering additional supporting documentation. Confidential interviews and a review of supportive documentation revealed that Law Enforcement responded to calls at the above facility 22 times for assaults, missing persons, suspicious circumstances, and follow-up investigations. Staff did follow the runaway procedures by contacting the non-emergency number to place a missing person report, provided important information regarding the minor and photo identification, and when the client returned the facility staff contacted the police department to close the missing persons' report. The habitual runaways did receive citations from law enforcement, and when a client was gone longer than 24 hours, a child and family team meeting was held to implement prevention interventions. Based on confidential interviews and review of supportive documentation, AGPA Woodard determined the lack of supervision allegation that staff do not provide adequate supervision to minors, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the findings are unsubstantiated. A copy of this report was left at the facility.

Investigation Findings:
13On November 22, 2022 at 1:10PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced complaint inspection at Kids to Kids - Faith House for the purpose of concluding the investigation and to deliver the findings. Upon arrival, AGPA Woodard was greeted by Lina Severino, Facility Manager. On November 3, 2022 the Department received a complaint regarding the above allegation. AGPA Woodard conducted the initial 10-day inspection on November 6th, 2022 and confidential interviews were conducted with two staff and two clients. On November 10th, AGPA Woodard conducted confidential interviews with the Reporting Party and HOS. continue on page 2 (LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: KIDS TO KIDS- FAITH HOUSEFACILITY NUMBER: VISIT DATE: 11/22/2022

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

met_with: Lina Severino


raw_content:
Investigation Findings:
13On March 7, 2023 at 9:15am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the findings. LPA spoke with FM and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: conflicting interview statements with house residents and staff members that reflected minimal evidence as to whether allegations occurred. Further, record reviews indicate evidence of provision of therapeutic services, administration of medication, and attempts to coordinate a 14-day notice for C1 with the placing county. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Madison Pennington, Facility Manager (FM)