raw_content:
Narrative:
Confidential interviews were conducted with twelve individuals during the period of 09/16/2022 to 01/26/2023, and attempted with seven individuals during the period of 11/21/2022 to 01/26/2023. The department has conducted a complaint investigation regarding the allegation: Staff restrained minor in care. There was insufficient evidence to state that staff inappropriately restrained a minor in care. Upon review of incident reports, and based on information gathered during interviews, restraints are permitted to be conducted as a last resort when there is a safety concern of danger to a youth or others, and is to be conducted by two CPI trained staff, including pertaining FC1. Per review of the facility Program Statement, "Physical intervention should only be used as a last resort, when all other attempts to defuse the crisis situation using non-physical means have been tried and found ineffective. They will only be used when an individual presents a danger to self or others and when the risks posed when an individual presents a danger to self or others." Staff who utilized restraints were CPI trained, and Incident Reports reviewed documented there was one restraint conducted in the month of September 2022 (on 09/28/2022). Incident Reports and staff interviewed both stated that there was a need for the restraint due to the youth being a danger to self or others, and after other de-escalation techniques were attempted and unsuccessful. Based on LPA interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. 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. An exit interview was conducted and a copy of this report was provided to Bill Ryland, Homes for Teens Director. Confidential interviews were conducted with twelve individuals during the period of 09/16/2022 to 01/26/2023, and attempted with seven individuals during the period of 11/21/2022 to 01/26/2023. The department has conducted a complaint investigation regarding the allegations: Staff did not provide a safe environment for children, Facility has insufficient staffing to meet children's needs, Staff do not report incidents as required, and Staff are not adequately trained to meet the needs of children in care. Based on interviews conducted, a staff reported they were asked to go home without completing an Incident Report on 09/10/2022, and another staff reported that they do not recall filling out an incident report for the incident involving FC1 on 09/10/2022. Review of incident Reports for three youth in care included incidents involving youth absence without permission, youth aggression and threats, and property destruction. The Incident Report pertaining to FC1 on 09/10/2022, could not be provided from the facility, and there is no evidence that the Law Enforcement Incident Report had been completed or submitted to the department as required. There was sufficient evidence to support that the facility had insufficient staffing to meet the children's needs. Based on review of clients' Needs and Services Plans and Assessments, documentation of the need for clients to have one on one or additional staff was not documented. Upon review of the facility's Program Statement, it states "During awake hours a minimum of two staff will be on duty at all time, 24 hours and day, 7 days a week. Depending on occupancy, the targeted awake ration is 1 staff to 2 youth." Based on review of staff schedules and time sheets, there were times when serious incidents occurred, but there was only one staff on shift, leaving youth in care with unmet safety needs. The physical environment of the facility was observed to be free of hazards during the Department's physical inspection of the facility, however through interviews and record reviews it was determined that staff present during multiple interventions were not sufficiently trained or capable in their skills to support the needs of the children in care, therefore not providing a safe environment. Upon review of Crisis Prevention Intervention (CPI) certificates, nine staff who worked at the facility did not complete training and obtain their certificates until 09/28/2022, however this was within the required 90 days after their hire date. continued on 9099-c Based on LPA observations, documentation reviewed, and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The facility is being issued three citations related to the complaint investigation and pertaining to deficiencies to the following regulations, Group Home ILS section 84065.5(c) If the children require special care and supervision because of age, problem behavior or other factors, the number of on-duty child care staff shall be increased; section 84061(i) The licensee shall submit reports to the Department, using form LIC 624-LE or a report containing all the information required in LIC 624-LE, regarding any incident that involves law enforcement contact with a child residing in the facility; and section 84065(i)(2) Sixteen hours of training shall be completed by new child care staff within 90 days of hire. An exit interview was conducted and a copy of this report and appeal rights were provided to Bill Ryland, Homes for Teens Director. Through record review of time sheets, it was determined that these staff completed their shifts while on shift with at least one CPI trained staff person during the month of September. Upon review of the facility's Program Statement, "If assaultive behavior continues to be displayed and a clear risk is perceived, staff may employ a team physical intervention as a last resort. Generally, this will involve the use of the CPI Team Control technique, with two staff members involved ensuring that the service user's upper and lower body strength is restricted, along with their mobility." Based on review of Incident Reports, assaultive behaviors from FC1 and FC3 did occur at the facility during the month of September, and while there was a minimal or inconsistent amount of CPI trained staff present, presenting an unsafe environment for clients in care, as well as staff. Due to staff not being able to physically intervene when appropriate, utilizing CPI curriculum, staff contacted Law Enforcement as an alternative to de-escalate youth who were threatening, or acting aggressively, toward youth in care and staff present, as a way to de-escalate unsafe situations. There was consistent evidence to determine that staff are not adequately trained to meet the needs of children in care, including interviews conducted with two staff who stated they did not receive initial or thourough training, felt unprepared and unsupported and were not given additional time to complete required training while on shift. Based on a review of the facility's Program Statement, it stated," All direct care staff shall receive two full days training in CPI Nonviolent Crisis Intervention® within three months of commencing in their post.." and "An additional 16-Hour training will be completed of the new direct care staff within 90 days of hire." Upon review of CPI certificates, nine staff who worked at the facility did not complete and obtain their certificates until 09/28/2022, however this was within the required 90 days after their hire date. Additionally, based on a review of training documents and certificates, it was determined that at the time of the incidents occuring in September 2022, the required 16 hour initial training for new staff was not yet due, with the due date being 90-days after their hire date. However, this training was either not completed or was not completed within the 90-day time-frame, as of February 07, 2023, for five out of ten staff whose training documentation was reviewed for a second time. continued on 9099-c

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on February 07, 2023 at 02: PM and met with Bill Ryland, Homes for Teens Director and Canaan Sampson, Facility Administrator Supervisor. The purpose of the inspection was to deliver complaint findings for the above allegations. On September 16, 2022 at 11: AM, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility to initiate a complaint investigation related to the above allegation. LPA met with Diana Macneill, Interim Facility Administrator and Yasmeen Sandoval, Facility Administrator. LPA completed a physical inspection of the group home, inside and out. During the course of the investigation, the following documents were gathered and reviewed: Incident Reports for three youth, Police Reports regarding the 09/10/ Incidents involving FC1, and FC3; Resident Assessments for three youth, Face Sheets for two youth, Needs and Services Plans for four youth, Placement Referrals (Kaiser) for three youth, Client census log, Staff Roster, Schedules, Time sheets, Program Daily Schedule, Safety Plans for three youth, and the Pre-Teen Behavioral Health Program Statement. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NO. Cal Cr/res., Natomas Park Dr., STE FACILITY NAME: KOINONIA BHP - AUBURNFACILITY NUMBER: 317006155

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


state: CA

facility_name: KOINONIA BHP - AUBURN

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
out of 11 interviews stated that there were room checks every 10-15 minutes throughout the night as well as if youths are in their room together. Also, there were no internal reports regarding any inappropriate interactions with staff and youth during the time frame that C1 was placed at this location. Lastly, due to C1's history of not telling the truth, their guardian reportedly held no concerns over their placement there. Although the allegations may have happened or is valid there is not a preponderance of evidence to prove the alleged violations did occur therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and Appeal Rights were discussed with Terri Anderson, Facility Administrator. A copy of this report and Appeal Rights were left at the facility.

Investigation Findings:
13On Februrary 21, Licensing Program Analyst (LPA) Sarina Buchannan conducted an unannounced visit to the Koinonia BHP Rocklin for the purpose of deliver findings to the above facility. LPA met with Terri Anderson, Facility administrator and was granted entry. During the investigation, LPA conducted the 10-day inspection of the facility on 10/02/2024. LPA obtained Staff schedules for August and September of 2022 with contact information, Facility Sketch, Client Roster, Facesheets, Needs and Service plans, Last 2 months of notes and records for the home. LPA and Investigator Brianna Abeyta conducted 11 confidential interviews between November 2024 and February 2025. Based on interviews conducted throughout the investigation, LPA received inconsistent statements. 9 of 11 interviews all stated that there are multiple staff on a shift with the youths and they are never left alone with another youth. (report continued on 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sarina Buchannan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA BHP - AUBURNFACILITY NUMBER: VISIT DATE: 02/21/2025

report_type: Complaint Investigation

met_with: Terri Anderson, Facility Administrator

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On 7/14/22 at 9:48am, Licensing Program Analyst (LPA) Stephanie Lor and Licensing Program Manager (LPM) Rosa Rodriouez conducted a Pre-Licensing Inspection, Component II and Component III at the above facility. LPA Lor and LPM Rodriguez met with the Administrator and Director. The facility consisted of a formal living room equipped with a set of couches, a covered fireplace, a desk for staff, a formal dining room equipped with a large table with 6 chairs. There is a resting area/second living room area equipped with a TV, a covered fireplace, board games, a shelf, and 3 couches. The kitchen was equipped with counter space, a working stove, locked cabinets to store the sharp objects/knives and dish soaps, plates, utensils, cups, silverware, and a large trash can with lid on. There is an area with 6 desks/chairs and 1 desk for staff, 1 office room will be used for staff and to lock the files and medication. There were hygiene products and cleaning supplies in the closet. There are 3 bedrooms equipped with two twin size beds, closets, 2 dresser, 2 night stand and storage. Bedroom #1 is equipped with a private bathroom. Laundry room equipped with a washer/dryer and lock cabinets to store the laundry/detergent soap. The backyard has a shed used for storage. There is small river creek accessible to clients and a sitting area with a table and chairs. There is a green thumb area for planting vegetables. The front yard was clean and free of hazards. The telephone land line and internet service were in working order. The water temperature was tested and it was at 140 degrees. There was plenty of perishable/non-perishable food available. The hallway cabinet has linens and towels. The garage has 2 freezers, 1 refrigerator filled with food, exercise equipment. There were can goods stored in the garage. There are cameras in the living room, garage, classroom area, dining room and hallway. (see 2nd page) During the Inspection, LPA Lor and LPM Rodriguez observed the following: 3 first aid kits which was missing the instruction booklet, 3 fire extinguishers, carbon monoxide and smoke detector system was tested and in working condition. Component II was completed on 6/15/22 with the Director via Teams and the following areas were discussed: table of content LIC 9106 page 7 age range, section Education Rights, section House Rules, section Discipline Policies, and section Chores. Component III was also completed during today's inspection and the following forms were reviewed with the Regional Program Director: LIC198A -Child Abuse Central Index Check for State Licensed Facilities (family child care homes; children's residential homes and facilities; and adult residential facilities if, through an approved exception or a specialized license, they provide care to a person under age 18), LIC198B - Out-of-State Child Abuse/Neglect Report Request, ·LIC 306-Reporting Requirements to Department. of Social Services, LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, LIC 501 - Personnel Record, LIC 503 - Health Screening Report (including TB Clearance), LIC 508 -Criminal Record Statement, LIC 508D - Out-of-State Disclosure & Criminal Record Statement, LIC 613B - Personal Rights, LIC 624 -Unusual Incident/Injury/Death Report, LIC 627B - Consent for Medical Treatment, LIC 9058 - Applicant/Licensee Rights, LIC 9182 - Criminal Background Clearance Transfer Request, LIC Criminal Record Exemption Transfer Request, Appendix D - A Guide to Safeguarding Resident/Client Cash Resources, LIC 311B - Records to be Maintained in a Group Home, LIC 311E - Records to be Maintained in a Small Family Home, LIC 313 - Evidence of Program Consultant (Group Homes), · LIC Identification and Emergency Information, LIC 602 - Physician's Report for Community Care Facilities, LIC 603 - Preplacement Appraisal Information, LIC 622 - Centrally Stored Medication and Destruction Record, LIC 625 - Appraisal/Needs and Services Plan, LIC 9106 - Group Home Program Statement, LIC 9106A - Short-Term Residential Therapeutic Program (STRTP) Statement General Instructions, LIC 9128 - Foster Family Agency Program Statement, Neighborhood Complaint Policy (see 3rd page) Administrator will purchase a new first aid kid, replace the light in one of the bedrooms and lower the water temperature. Exit interview conducted with the Administrator and a copy of the report will be emailed to the facility.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Patti Ambriz, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and an inspection was completed on today's date. An inspection was completed of the inside and outside of the facility. It was observed during a physical inspection of the facility that the staff office was unlocked and a filing cabinet inside the staff office, containing the client records, was left unlocked, allowing clients and other unauthorized visitors to have potential access to the client files. A Technical Advisory - Technical Violation was issued related to the inspection and California Code of Regulations, Title 22, division 6, chapter 1, section 80070(c)(1) The licensee shall be responsible for safeguarding the confidentiality of record contents. A copy was this report was left with Diana Macneill, Interim Facility Administrator

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 8/1/23, Licensing Program Analyst (LPA) Stephanie Lor made an unannounced visit at the agency for the purpose of completing a required Annual Inspection. LPA met with Office Manager who gave a tour of the facility. LPA conducted a walk-through of the facility inside and out. LPA observed working smoke detectors and carbon monoxide detectors. The living room was observed to have adequate furniture and lamps. LPA observed 3 bedrooms and staff office. Bedroom 1 will have all required mattresses and bedding once client is placed. Kitchen cabinet will be fixed once facility is in operation. All bathrooms were tested and working. Laundry room equipped with a washer/dryer and lock cabinets to store the laundry/detergent soap. There were 3 fire extinguishers on site and a first aid kit with all required items. The front yard was clean and free of hazards. The backyard has a shed used for storage. The water temperature was tested and it was at 117 degrees. There is currently no staff or client at this facility, therefore LPA did not review any files or conducted interviews. LPA reviewed the physical, operations and disaster plan domain. An exit interview was conducted with the Office Manager. A copy of the report was provided to the facility.

visit_type: Annual

met_with: Camilla Ryland, Office Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Sara Luman-Gonzalez and Sarina Buchannan made an unannounced inspection on 08/01/2024 at 11: A.M. During the inspection LPA met with Canaan Sampson, Facility Supervisor who assisted with the inspection.LPAs conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection was observed to be 0 clients with 1 staff member present. Number of staff interviewed Number of clients interviewed LPAs observed 3 bedrooms and 3 bathrooms LPAs Sara Luman Gonzalez & Sarina Buchannan inspected and/or reviewed the following: Physical Plant LPA's observed the necessary documentation such as Personal Rights, Facility License, Grievance Policies, Chores, Laundry and other documentation posted on the wall. All disinfectants/cleaning solutions were observed to locked away in a closet. Sharps were also locked away in the kitchen area. Fridge, Freezer and pantry were observed to be adequately stocked with both perishable and non-perishable foods. Fridge was observed to be below 45 degrees and Freezer was observed to be below 0 degrees. A back up fridge and freezer in the garage area. There are 2 vans registered to the facility, one was leaving for the shop upon LPA's arrival and the other was registered and in compliance. Hot water was tested throughout the facility and was observed to 124 degrees. A working phone was observed to be in the living room area. Carbon monoxide/Smoke detectors were tested and observed to be fully functional. Fire extinguishers were observed to be serviced and fully charged. All common area furniture was observed to be in good repair with adequate room for seating for the capacity. The medications area is observed to in the locked office in a locked drawer. (Page 1 of 2) Bedrooms were furnished and in good repair with linens in the hallway closet. All bathroom fixtures were observed to in good repair with soap and paper towels in each. There is a locked shed in the rear yard with holiday decorations and maintenance equipment. LPAs observed the facility to be free of vermin. Operations Complaint procedures were reviewed along with Board Minutes. All observed to be in compliance. Disaster Preparedness Disaster and Mass Casualty Plan was observed to be posted. Drills are conducted monthly. Emergency Intervention Due to the facility not having any clientele there was no manual restraint log on file however, Facility Supervisor was able to provide one online. There are no staff assigned to the facility but training for the Facility Supervisor was up to date. The following items were reviewed for compliance in the regional office prior to the facility inspection: · Annual fees · Administrator Certificate for: Katie Danner & Canaan Sampson · Emergency Disaster Plan (per H&S Code 1565) · Mental Health Program Certificate Expires: 2025 · Annual Emergency Intervention Log · Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC An exit interview was conducted with Canaan Sampson and a copy of this report was left at the facility.

met_with: Canaan Sampson, Facilitiy Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On April 23, 2025 at 10:15 am Licensing Program Analyst (LPA) Maie Soliman and Licensing Program Manager (LPM) Dara Campos made an announced visit for the purpose of converting the facility type from a Group home to a SHORT TERM RESIDENTIAL THERAPEUTIC PROGRAM (STRTP) LPA and LPM met with Canaan Sampson, Facility Administrator Supervisor, Sara Busse, Program Director, Alyssa Miller, Office Manager, Aimee MarieL. Zapata, Clinical Facility Administrator. The facility provided the Group Home license to LPA/LPM. There are no clients in the home.

met_with: CANAAN SAMPSON, Adminstrator


facility_name: KOINONIA BHP - LOOMIS

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
It was reported during the interview process that C1 did not have a history of lying. Staff confirmed that clients were not being monitored every fifteen minutes during the night, and the facility was not able to provide video footage to prove that the room checks were consistently completed throughout the night. Lastly, Staff reported that C2 has a history of inappropriate behavior. Based on LPA observation and interviews which were conducted and records review, Preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5, 84072(d)(19) Personal Rights is being cited on the attached LIC 9099D. Exit interview was conducted, Appeal Rights were discussed with Juan Magallon, Facility Administrator and copy of this report were left at the facility.

Investigation Findings:
13On 8/28/2024, Licensing Program Analyst (LPA) Sara Luman-Gonzalez conducted an unannounced visit to the above agency to deliver the findings of a complaint investigation. LPA met with Juan Magallon, Facility Administrator and was granted entry. During the investigation, LPAs Farhaan Sarangi and Sara Luman-Gonzalez conducted the 10 day inspection of the facility on 1/29/2024, no deficiencies were cited at that time. LPA obtained Needs and Services Plans, Case Notes from October 2024 to January 2024, Incident Reports for all clients from October 2024 to January 2024, Staff Roster for both December and January, and Client Roster for December and January. IB Investigator Sergio Guerra conducted 12 confidential interviews between December 2023 and August 2024. Based on the forensic interview conducted on 1/30/2024, C1 was consistent with the timeline of events. Even though C2 denied the allegation, C3 and C4 confirmed that C1 was victimized by C2. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sara Luman-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA BHP - LOOMISFACILITY NUMBER: VISIT DATE: 08/28/2024

met_with: Juan Magallon, Facility Administrator

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On November 22, 2021 at 12:00PM License Program Manager, Rosa Rodriguez (LPM), and License Program Analyst, Yuvi Diaz (LPA) conducted Prelicensing Inspection of this facility. LPM and LPA met with administrator, Bill Ryland who gave a tour of the interior and exterior areas of the facility's physical plant. The backyard has a pool with a fence that is at least five feet tall that meets Title 22 regulations, the fence does not obscure the view, and it has a self latching device. The front and back yards were free of clutter; No potentially hazardous items or areas were observed. The facility consisted of a kitchen, dining room space, living room space with clean couches, large TV, game room/group room, three bedrooms furnished with two beds, night stand and dresser, two bathrooms, one staff bathroom ,one office space and clinician office. License, personal rights, and disaster plan were all posted in the facility. The temperature in the room was at 70. Fire extinguisher was up to date. LPA and LPM also noted the facility had two refrigerators with at least 7 days worth of non-perishables and 3 days worth of perishables. LPA/LPM noted locked cabinets for client files and medications to be stored in a safe location.. No structural defects to the house was observed by LPA/LPM: the windows and window screens were in good repair and there were no unfinished areas. Fire alarms and carbon monoxide alarms were working. First aid was fully stocked. All domain of the tool were completed: Physical plan, operations, disaster preparedness, and client records. An exit interview was conducted with administrator. A copy of this report will be emailed to the administrator.

met_with: William Ryland


summary: Facility Evaluation

raw_content:
Narrative:
On 8/4/22 at 10:30am, License Program Analyst, Stephanie Lor (LPA) conducted a post-licensing inspection at the above facility. LPA met with Facility Administrator who gave a tour of the interior and exterior areas of the facility. All required posters were posted by the front entrance. Bedroom 1, 2, and 3 have 2 twin size beds, closets, trash cans with lids, and working lights. All 3 bathrooms had running water and the water temperature was at 117. There is 1 staff office. The hallway closet consisted of hygiene products and towels. Living area 1 consisted of a couch, desk and a piano. Living area 2 consisted of 2 couches, 2 tables, tv, locked cabinets, art supplies storage, a locked closet for the washer and dryer, and a locked closet for an extra refrigerator and pantry with at least 7 days' worth of non-perishables and 3 days' worth perishable. The backyard has a pool with a fence that is at least five feet tall that meets Title 22 regulations, and it has a self-latching device. The locked shed consisted of youth's personal belongings. There were cameras observed in the common areas. Fire alarms and carbon monoxide alarms were working. There were 2 fire extinguishers and 1 first aid kit. LPA reviewed 2 youth files, 3 staff files, and interviewed 1 youth. Two technical assistance were provided during this inspection. All domains of the tool were completed: Physical plan, operations, disaster preparedness, emergency intervention, staffing, and client records. An exit interview was conducted with administrator. A copy of this report will be emailed to the administrator.

met_with: Jordan Myers, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/19/22, License Program Analyst, Stephanie Lor (LPA) conducted an annual inspection at the above facility. LPA met with Facility Administrator who gave a tour of the interior and exterior areas of the facility. Prior to the inspection, LPA reviewed: annual fees, administrator certificate, accreditation, expiration date, waivers and exception, and personnel roster. All required posters were posted by the front entrance. Bedroom 1, 2, and 3 have 2 twin size beds, closets, trash cans with lids, and working lights. LPA Lor observed a hole in bedroom #1. Administrator provided a work order proof of the work in progress. All 3 bathrooms had running water and the water temperature was at 105 degree. There is 1 staff office. The hallway closet consisted of hygiene products and towels. Living area 1 consisted of a couch, desk and a piano. Living area 2 consisted of 2 couches, 2 tables, tv, locked cabinets, art supplies storage, a locked closet for the washer and dryer, and a locked closet with an extra refrigerator and pantry with at least 7 days' worth of non-perishables and 3 days' worth perishable. The backyard has a pool with a fence that is at least five feet tall that meets Title 22 regulations and it has a self-latching device. The locked shed consisted of youth's personal belongings. There were cameras observed in the common areas. Fire alarms and carbon monoxide alarms were working. There were 2 fire extinguishers and 3 first aid kits. The 2 vehicles were observed to be in good repair. LPA reviewed 2 youth files, 5 staff files, interviewed 2 clients, and interviewed 2 staff. 2 type B citations were given for torn window screens and a broken door closet. A Technical Violation was given to install screen windows to bedroom#3. This report was discussed with the Facility Administrator and a copy was provided to the facility.

met_with: Jordan Meyer, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/30/22, Licensing Program Analyst (LPA), Stephanie Lor conducted a case management over the phone to follow up on the annual inspection on 12/19/22. LPA Lor spoke with the Administrator regarding their phone call and house rule policy. The Administrator went over their policy with LPA Lor. The requested documents were emailed to LPA Lor on 12/21/22. LPA Lor reviewed the Program Statement and it was determined that no violations have occurred. An exit interview was conducted with the Administrator and a copy of this report will be emailed to the facility. This case management investigation is closed.


summary: Facility Evaluation

raw_content:
Narrative:
On this day January 29, 2024, Licensing Program Analysts (LPAs) Sara Luman-Gonzalez and Farhaan Sarangi conducted a Case Management-Other inspection. LPAs met with Facility Administrator, Jordan Myers and was granted access into the facility. During the Case Management-Other inspection, LPAs observed that the pool fence did not have a lock on it. LPAs educated the Administrator regarding the importance of having locks on the pool (See LIC 9102-Technical Violation). No deficiencies were cited during today's Case Management-Other inspection. Exit interview was conducted, and a copy of this report was given to the Administrator.

met_with: Jordan Myers- Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Orlando Areizaga and Sara Luman-Gonzalez made an unannounced Annual inspection on Thursday December 19, 2024 at 9: AM. During the inspection LPAs met with Canaan Juan Magallon, Facility Adminsitrator who assisted with the inspection. LPAs Areizaga and Luman-Gonzalez conducted a walk-through of the facility interior and exterior. Facility staff client ratio at time of inspection were 2 staff to 3 youths in care. Number of staff interviewed Number of clients interviewed LPAs observed # 3 bedrooms, # 3 bathrooms LPAs Areizaga and Luman-Gonzalez inspected and/or reviewed the following: Physical Plant: LPA's observed the necessary documentation, such as the Emergency ID form, License, Personal Rights, and Grievance Policies. There are 3 working phones throughout the facility. Cleaning/Disinfectants were locked along with Laundry Supplies. Smoke Detectors/Carbon Monoxide were tested and observed in working order. Fire Extinguishers were charged and in two locations in the facility. Multiple First Aid Kits were observed throughout the facility to be fully stocked. Fridge was below 45 degrees and Freezer was below 0. Hot water was tested at 110 degrees. Menu for the week was posted on the door. 2 weeks of Non-perishable items and 5 days of perishable items were observed in the kitchen area. Common areas were easily accessible with plenty of seating space for staff and youths placed at the facility. Medication centrally stored is locked/inaccessible. Office is locked. Toilets wash basin, bath and shower fixtures in good repair/no leaks. Soap and Paper towels in the restroom. Laundry Facilities with schedule in a central area. (Page 1 of 3) Bedrooms-required linen and furnishings were observed in the home. Bedroom (required bedding/furniture, furniture were observed in good repair. Two Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts. Facility free of vermin. Locked Facilities (open locked storage area/building/sheds) were accessible to the Department. Operations: Complaint Procedures For Youth Reviewed and are posted in the entryway. Board Minutes Reviewed. Disaster Preparedness: Disaster and mass casualty plan updated and available in the entryway. Quarterly Drills conducted and documented in a separate binder. Disaster preparedness supplies verified in a closet in the office. Emergency Intervention: Review of manual restraint log; No restraints within the year. Staff training is up to date. Staffing/Volunteers: Number of Staff files reviewed: 5. All Criminal Record Clearances, First Aid, CPI, Job Title/Qualifications. and Training were verified. Administrator Certificate verified. Client Records: Clients files reviewed: 5. Needs an Services Plans, Psychotropic Medications, Centrally Stored Medications, Cash Resources and Compatibility Assessment were observed in their respective binders. Core/Therapeutic Services: Trauma Informed Practices are implemented as a part of the core of the Facility. Other forms of therapy, Equine, are used with the youths. (Page 2 of 3) The following items were reviewed for compliance in the regional office prior to the facility inspection: · Annual fees: $454.00 · Administrator Certificate for: Juan Magallon · Emergency Disaster Plan (per H&S Code 1565) · Annual Emergency Intervention Log · Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC 308 · Waivers and Exceptions An exit interview was conducted with Juan Magallon, Facility Administrator and a copy of this report was left at the facility.


facility_name: KOINONIA BHP - ROCKLIN

summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Narrative:
In addition, there were no documentations of meeting with responsible parties to discuss the client's discharge from the program. Lastly, the responsible party was not aware or informed of any 14 days' discharge notice from the placement. Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5 are being cited on the attached LIC 9099D. An exit interview was conducted with the Administrator. A copy of this report and the Appeal Rights were provided to the agency.

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

Deficiencies:
84068.4(b): 1
2
3
4
5
6
7

met_with: Katie Danner, Administrator

title:
The licensee shall ensure that the child and his/her authorized representative(s) are offered the opportunity to participate in the development of a discharge plan for the child.
This standard is not met as evidenced by

description:
1
2
3
4
5
6
7


raw_content:
Narrative:
Based on the interviews conducted, there were no collaboration that staff abandoned minor at the hospital. When interviewing C3, C3 reported that staff S2 was with C3 the entire time at the hospital. C3 stated that the only time C3 was alone was when the staff stepped out to use the restroom, but a security guard would supervise C3. Another youth confirmed that staff never left them alone at the hospital. In addition, S2 denied leaving youth at the hospital. When interviewing other facility staff, staff could not confirm whether C3 was left alone or not at the hospital. It was reported that they've only heard of the incident from other staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted with the Administrator. A copy of this report and the Appeal Rights were provided to the agency.

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

met_with: Dustin Blum, Administrator


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
On the allegation of "staff did not file incident report," there were collaboration that youth burned their hand while on an outing. Youth confirmed that the incident occurred and stated that the youth denied first aid kit. Although it was reported that staff offered first aid kit to the youth, there were no records of incident report submitted for this incident. Amended section: Although the injury did not appear to require medical attention, a burn is still considered an unusual incident requiring an incident report as burns can develop well within the next 24 hours of the incident. During the investigation it was determined that section 80061 (b)(D) was cited incorrectly under the section of the regulations. Therefore, the department will change the regulation to the correct regulation 80061 (b)(1)(E), which states that any unusual incident or client absence which threatens the physical or emotional health or safety of any client be reported. Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division Chapter 1 are being cited on the attached LIC 9099D. An exit interview was conducted with the Administrator. A copy of this amended report was provided to the agency.

Investigation Findings:
13This is an amendment report and supersedes the original report dated on 6/23/23 issued by Licensing Program Analyst (LPA) Stephanie Lor. On 10/11/23, LPA met with the Administrator to discuss the amended finding for above allegation. LPA conducted the 10-day inspection of the facility on 4/12/23. No deficiencies were cited at that time. LPA obtained copies of Youth Needs and Service Plans, safety plan for youth, timesheet and schedule for staff for 3/27/23, incident reports, and protocol documents. LPA conducted 19 confidential interviews and 1 attempt between April-June 2023. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Stephanie Lor LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: KOINONIA BHP - ROCKLINFACILITY NUMBER: VISIT DATE: 06/23/2023


raw_content:
Narrative:
Based on interviews conducted during the investigation process, these allegations cannot be substantiated because the facility has already been cited for the same allegations on complaint received April 03, 2023. Even though the allegations occurred and were confirmed by documentation received/reviewed by LPA Lor, the Department has previously cited the same facility for the same allegations; therefore the allegations of "Staff did not seek medical attention to minor in care and staff did not file incident report" are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiencies were cited. An exit interview was conducted with the Administrator. A copy of this report and the Appeal Rights were provided to the agency.

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


raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiencies were cited. An exit interview was conducted with the Administrator . A copy of this report and the Appeal Rights were provided to the agency.

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


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted with the Administrator. A copy of this report was provided to the agency.

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


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report was provided to Administrator Assistant, Hannah Erb.

Investigation Findings:
13On January 22, 2024 at approximately 11: AM Licensing Program Analysts (LPA) Farhaan Sarangi and Sara Luman-Gonzalez conducted a complaint investigation inspection at Koinonia BHP-Rocklin and met with Administrator Assistant, Hannah Erb for the purpose of delivering findings. During the investigation, LPA Sarangi reviewed the complaint history, criminal background check, incident reports and facility personnel report summary. LPA also reviewed facility files which included a Program Statement. LPA Sarangi conducted interviews with staff and children in placement. Based on the interviews that were conducted, LPA could not prove or disprove that the above allegation occurred. During interviews, LPA received inconsistent statements. However, LPA learned that the facility staff members attempted to redirect children but were unsuccessful. A review of the Program Statement under Emergency Intervention Plan revealed that the facility will attempt to address the inappropriate behavior utilizing the least amount of intervention. (Report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA BHP - ROCKLINFACILITY NUMBER: VISIT DATE: 01/22/2024

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

met_with: Administrator Assistant, Hannah Erb


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Furthermore, LPA reviewed video footage which confirmed one of the youths going in and out of the other youth's bedroom that morning. Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of the evidence standard has been met, there for the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, are being cited on the attached LIC 9099D. Exit interview conducted and a copy of this report and Appeals Rights were given to Linda Wagner.

Investigation Findings:
13On March 11, 2024 at approximately 10: A.M. Licensing Program Analysts (LPAs) Sara Luman-Gonzalez, Tatyana Shulz, and Jacqueline Carmona arrived unannounced at Kononia BHP-Rocklin and met with Linda Wagner,Facility Administrator for the purpose of delivering findings. During the investigation, LPA reviewed the facility's file at the licensing office, including the complaint history, criminal background check, and incident reports. LPA also reviewed the Needs and Services Plans, Case Notes, Staff Roster, and Video Footage from the night of the incident. LPA conducted 10 confidential interviews during the investigation process. Based on the interviews conducted, the allegation above is being substantiated because LPA received consistent statements regarding how one youth entered another youth's room without staff knowledge twice between 4:45am - 5:00am on 01/19/2024. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sara Luman-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA BHP - ROCKLINFACILITY NUMBER: VISIT DATE: 03/11/2024

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

met_with: Linda Wagner- Facility Administrator


raw_content:
Narrative:
out of 12 interviews stated that staffing ratios assured that the youths were not left alone with each other long enough for a sexual assault to occur. 10 out of 12 interviews confirmed that there were bed checks every 10-15 minutes and that doors had to be left open where the staff could see inside the room to verify where youths were. Also, there were no internal reports regarding any inappropriate interactions between staff and youth during the time of C1's placement at this location. Lastly, due to C1's history of not telling the truth, their guardian reportedly held no concerns over their placement there. Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violations did occur therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and Appeal Rights were discussed with Terri Anderson, Facility Administrator. A copy of this report was left at the facility.

Investigation Findings:
13On February 21, 2025 at 12: PM Licensing Program Analyst (LPA) Sarina Buchannan conducted an unannounced visit to the above facility to deliver the findings of a complaint investigation. LPA met with Terri Anderson, Facility Administrator and was granted entry. During the investigation, LPA Luman-Gonzalez and LPA Orlando Areizaga conducted the 10-day inspection of the facility on 11/06/2024. LPA obtained Staff Roster and Child Roster from September 2022 to May 2023, Facility Sketch, Case Notes for C1. 12 confidential interviews were conducted between November 2024 and February 2025 by LPA Luman-Gonzalez and Investigator Brianna Abeyta. Based on interviews conducted throughout the investigation, LPA and IB Investigator received inconsistent statements. (Report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sarina Buchannan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA BHP - ROCKLINFACILITY NUMBER: VISIT DATE: 02/21/2025


summary: Facility Evaluation

raw_content:
Narrative:
On 7/14/22 at 1:00PM, Licensing Program Analyst (LPA) Stephanie Lor and Licensing Program Manager (LPM) Rosa Rodriguez conducted a Pre-Licensing Inspection, Component II and Component III at the above facility. LPA Lor and LPM Rodriguez met with the Administrator. The facility consisted of a living room equipped with a set of 3 couches, TV and a staff desk, a formal dining room equipped with a large table with 2 chairs and 2 benches. There is a fire place in the dining room, which staff was informed to cover up. The kitchen was equipped with counter space, locked cabinets to store the sharp objects/knives and dish soaps, plates, utensils, cups, silverware, and a large trash can with lid on. 1 office room upstairs will be used for the Therapist, the room included a desk, 2 couches, and 1 first aid kit. The 2nd office room upstairs will be used for staff and to lock the files. The 2nd office room contains 2 desks, 2 trash cans with lid, 2 first aid kits, closet for supplies, and storage for staff personal items. There is a working land line in the facility. The garage contains a washer and dryer, 2 refrigerators, a cabinet for detergent, and storage for can goods. There are 3 bedrooms equipped with 2 twin size beds, closet (curtain will be installed) dresser, night stand, and trash can with lids. The 2 bathrooms have trash cans with lids. The bathroom upstairs will be used for staff and the one downstairs will be used by clients. Both bathrooms were in good repair, the water temperature was tested and the temperature was between 105-120 degrees. The hallway cabinet was filled with board games, blankets, towels, and hygiene products. The backyard has a pool with a cover that meets the Regulations. The cover was tested by having a staff walked over the cover. There was a basketball court area. There was an electric extension cord connected from the house to the pool cover motor, which can cause tripping hazard. Staff was notified to remove the cord. Staff was also notified to cover the pool pump area with a gate to make it inaccessible to clients. Staff will remove the cinder blocks, wood pieces and tree branches from the backyard. () During the pre-inspection, LPA Lor and LPM Rodriguez observed the following: 3 first aid kit with all items, 2 fire extinguishers located in the second floor hallway and in the kitchen area, carbon monoxide and smoke detector were tested and were in working condition. There were 4 cameras observed in the home. A camera was located on the stairway, downstair hallway, living room and dining/kitchen area. There is no waiver on file to indicated that it was previously approved by CCL, LPA will check the Regulations to ensure a waiver is not needed. Component II was completed on 6/15/22 with the Director via Teams and the following areas were discussed: table of content LIC 9106 page 7 age range, section Education Rights, section House Rules, section Discipline Policies, and section Chores. Component III was also completed during today's inspection and the following forms were reviewed with the Regional Program Director: LIC198A -Child Abuse Central Index Check for State Licensed Facilities (family child care homes; children's residential homes and facilities; and adult residential facilities if, through an approved exception or a specialized license, they provide care to a person under age 18), LIC198B - Out-of-State Child Abuse/Neglect Report Request, LIC 306-Reporting Requirements to Department. of Social Services, LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, LIC 501 - Personnel Record, LIC 503 - Health Screening Report (including TB Clearance), LIC 508 -Criminal Record Statement, LIC 508D - Out-of-State Disclosure & Criminal Record Statement, LIC 613B - Personal Rights, LIC 624 -Unusual Incident/Injury/Death Report, LIC 627B - Consent for Medical Treatment, LIC 9058 - Applicant/Licensee Rights, LIC 9182 - Criminal Background Clearance Transfer Request, LIC Criminal Record Exemption Transfer Request, Appendix D - A Guide to Safeguarding Resident/Client Cash Resources, LIC 311B - Records to be Maintained in a Group Home, LIC 311E - Records to be Maintained in a Small Family Home, LIC 313 - Evidence of Program Consultant (Group Homes), · LIC Identification and Emergency Information, LIC 602 - Physician's Report for Community Care Facilities, LIC 603 () - Preplacement Appraisal Information, LIC 622 - Centrally Stored Medication and Destruction Record, LIC 625 - Appraisal/Needs and Services Plan, LIC 9106 - Group Home Program Statement, LIC 9106A - Short-Term Residential Therapeutic Program (STRTP) Statement General Instructions, LIC 9128 - Foster Family Agency Program Statement, Neighborhood Complaint Policy The following items needed to be completed before issuing the license: electrical extension cord need to be removed, wood and cinder block need to be removed, pool pump covered must be inaccessible to clients with a lock, all bedrooms must have curtains in the closet, all the required forms to appoint the new Administrator to this facility. Administrator will email all the requirements to LPA Lor. Exit interview conducted with Administrator and a copy of the report will be emailed by 07/15/2022.


summary: Facility Evaluation

raw_content:
Narrative:
On November 04, Licensing Program Analyst (LPA) Stephannie Verna arrived unannounced at the facility for the purpose of conducting confidential interviews, with clients and staff, related to a complaint investigation at another facility. LPA Verna met with Katie Danner, Facility Administrator. LPA completed an inspection of the facility and there were no deficiencies observed. LPA completed 3 interviews. Clients to be interviewed have been discharged from the facility and could not be interviewed during this visit. Further investigation is needed to complete the complaint investigation at another facility. A signed copy of this LIC-809 report was provided to the facility. An exit interview was conducted.

met_with: Katie Danner, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 7/18/23, Licensing Program Analyst (LPA) Stephanie Lor made an unannounced visit at the agency for the purpose of completing a required Annual Inspection. During the inspection, the LPA met with the Administrator. LPA observed all required postings posted. LPA observed working smoke detectors and carbon monoxide detectors. There are 2 offices used for staff. The staff office consisted of locked files, desks, and lockers. LPA observed 3 bedrooms with appropriate bedding and furniture. All bathrooms were tested and working. The water tested at the required temperature at 106*. The locked hallway cabinet contained extra linens, towels, blankets, cleaning supplies, and hygiene products. All cleaning chemicals were locked and inaccessible to clients. LPA observed medications and sharps to be locked. There were 2 fire extinguishers on site. LPA reviewed 5 staff and 3 youth files, all required documents were observed in the files. First aid kits had all required items. LPA interviewed 2 staff and 2 clients. LPA observed the kitchen refrigerator, freezer and pantry to be filled with perishable and non- perishable food items. LPA observed an adequate supply of utensils, dishes and a menu. A trash bin with a lid is located in the kitchen. The living room was observed to have adequate furniture and lamps. A laundry room with a washer and dryer is available to the clients. LPA observed the outdoor area to be clear of clutter and debris. The pool had a pool cover and a latched gate. The garage consisted of 2 refrigerators with food, tables, and extra supplies. A Type B citation was issued for missing TB testing. An exit interview was conducted with the Administrator. A copy of the report will be email to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On May 6, 2024, at approximately 2: P.M., Licensing Program Analyst (LPA) Sara Luman-Gonzalez arrived at the above Facility for the purpose of conducting a Facility Inspection. LPA met with Facility Administrator (FA), Linda Wagner and toured the facility. No deficiencies were noted at this time. LPA asked FA about the incident on 4/15/24 where a youth in care had access to exposed wiring and nails. FA clarified that Youth had kicked in the outlet area near the door of their bedroom exposing the nails and wiring. After calming the youth in care, FA placed a call to maintenance who arrived the next day to fix the issue. FA clarified that they had covered the hole with cardboard and tape overnight until maintenance arrived. LPA observed the call log on FA's personal phone. LPA observed no deficiencies at this time. An Exit Interview was conducted and a copy of this report was left at the facility.

met_with: Linda Wagner, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Sara Luman-Gonzalez made an unannounced inspection on July 18, 2024 at 10: A.M. During the inspection LPA met with Hannah Erb, Facility Adminstrator Assistant and Canaan Sampson, Facility Supervisor who assisted with the inspection. LPA Luman-Gonzalez conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection 6 staff & 2 children. Four (4) staff interviewed & Two (2) clients interviewed. LPA observed Three (3) bedrooms, Three (3) bathrooms. LPA inspected and/or reviewed the following: Physical Plant License and Personal Rights are posted in the entry way. All medications and cleaning solutions are locked up separately. Fridge was below 45 degrees Freezer was below 0 degrees. LPA observed plenty of perishable and nonperishable foods. In the kitchen area is where the menu is posted and the phone is on the staff desk near the dining area. Smoking and Carbon Monoxide were observed in working order. First aid kits were observed throughout the home all fully stocked. Common area and dining area are adequately furnished and in good repair. Offices are upstairs and locked. Upstairs bathroom and downstairs bathrooms water was tested at 110 degrees; fixtures were all in good repair. Soap was accessible, paper towels were available, and bath towels were found in each child's box. Bedroom linens are in the closet by the bedrooms; observed to be clean. Bedroom furniture was observed to be in good repair. One facility van was in the shop for maintenance at the time of LPA's visit. Other facility vehicle was observed to be in good repair with current documentation. Locked shed outside houses crates and lawn care equipment. LPA observed the facility to be free of vermin. (Page 1of 3) Operations Board minutes from the past two (2) quarters reviewed. Complaint procedures were reviewed. Disaster Preparedness Disaster and Mass Casualty plan was available for review and Monthly disaster drills are conducted. Disaster preparedness supplies were available in the garage area. Emergency Intervention Manual Restraints log was reviewed; Staff training was up to date and LPA observed the schedule for new trainings. Staffing/Volunteers Six (6) staff files were reviewed with Criminal Record Clearances, First Aid Certificates all up to date. Qualifications and Trainings were verified and up to date. Administrators certificate was observed to be current. Client Records Two (2) client files reviewed. Medications and Parent permissions were signed off and current. Both forms were filled out correctly. Cash Resources were observed to be up to date and Needs and Services Plans were signed. Core/Therapeutic Services Trauma Informed and Trust Based Relational Interventions are practiced within the facility and on outings/activities. Youths were observed returning from Equine Therapy upon LPA's arrival. Special Health Care Needs (SHCN) Staff have received training's for caring for youths with incontinence and enuresis. Staff cleans and disinfects home. (Page 2 of 3) The following items were reviewed for compliance in the regional office prior to the facility inspection: · Annual fees · Administrator Certificate for: Linda Wagner · Emergency Disaster Plan (per H&S Code 1565) · Annual Emergency Intervention Log · Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC 308 · Waivers and Exceptions An exit interview was conducted with Canaan Sampson, Facility Supervisor and a copy of this report was left at the facility.

met_with: Canaan Sampson, Facility Supervisor


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On December 26, 2023 at approximately 09: AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Koinonia BHP-Rocklin for the purpose of conducting a Case Management-Deficiencies inspection. LPA was greeted at the door by Mental Health Support Worker, Dustin Blum, and was granted access into the facility. During the Case Management-Deficiencies inspection, LPA reviewed documents and observed that a Needs and Services Plan was not retained in client files and there was no Needs and Services Plan completed for the child in care due to the previous clinician walking off the job. LPA was made aware that the clinician walked off the job in Late October, 2023 (See LIC 809D). Deficiencies cited from the California Code of Regulations. Appeal rights were given. Failure to correct the deficiency and/or repeated deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted, and a copy of this report was signed and given to the Mental Health Support Worker, Dustin Blum

Deficiencies:
84070: (c)	If it is determined that the facility can provide the services necessary to meet the child's needs, the following additional information shall be maintained in the child's record:

(1)	A copy of the child's original needs and services plan; verification, signed by the child and his/her authorized representative(s), that they were offered the opportunity to participate in plan development; and verification that the authorized representative(s) have approved the plan.1
2
3
4
5
6
7Plan of Correction shall include the Licensee/Administrator to submit an LIC 9098-Self Certification and to train staff on retaining ALL children records that are open for inspection. In addition, Licensee/Administrator shall submit a plan for future compliance.
8
9
10
11
12
13
14

title: Children's Records


summary: Facility Evaluation

raw_content:
Narrative:
On April 11, 2024 at 9: A.M. Licensing Program Analyst (LPA), Sara Luman-Gonzalez made an unannounced inspection to conduct a case management regarding two incident reports received by the Department on 3/21/24 and 3/27/24 regarding medication error, client 1 and client 2 were provided over the counter medication without parental consent on 3/15/24 and it was discovered on 3/20/24 for client 2. LPA met with Linda Wagner, Facility Administrator. Based on interviews conducted with all parties involved including, facility staff, clients, and Administrator, it was confirmed that both incidents took place. The facility has been cited for Personal Rights (See LIC809D). The facility has conducted additional training's with the staff on how to properly dispense medication, plan of correction has been cleared during today's inspection. LPA Sara Luman-Gonzalez obtained the signed training material given to the staff. An exit interview was conducted with Facility Administrator and a copy of this report and the appeal rights were given to the Facility. This case management inspection is closed.


facility_name: KOINONIA CRISIS RESOLUTION CENTER

raw_content:
Narrative:
On January 9th, The Department was notified that a staff member had been arrested for sexual relations with a minor who was not a current client at the facility. The Youth was a previous client of the facility but was not in care at the time of the arrest. Interviews revealed conflicting information. One interview revealed that while the Youth was in care, the Staff member gave the youth his phone number, and began following the Youth on Instagram, stating he could take photos of her to use for her profile. Additionally, while on walks with the Youth, the Staff member would make sexual innuendos. Interviews with staff revealed conflicting information. Four staff members were interviewed in addition to the Administrator and Administrator's Supervisor. Only one staff member interviewed stated that they did witness what could be considered an inappropriate interaction, when the staff member and Youth were tying each others shoes. This staff stated they reported it to the Administrator. The Administrator stated nothing was ever reported to her about the shoe tying incident. No other staff members mentioned hearing or seeing anything inappropriate between the Staff and Youth while she was in care. This Department has investigated the complaint alleging Staff had inappropriate relationship with minor. We have found the complaint to be Unsubstantiated, meaning that 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. Exit interview conducted with Connie Treacy. A copy of this report and appeal rights were given.

Investigation Findings:
13On Thursday, April 17th, 2025, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced investigation inspection at the Facility, to deliver findings for the allegation listed above. LPA met with Administator Connie Treacy who assisted with the inspection. LPA conducted the initial-10 day complaint investigation at the Facility on 1/22/25. Between 1/22/25 and 4/9/25, LPA interviewed the Administrator (A1), the Administrator Supervisor (AS), four staff members (S2, S3, S4, S8), the Youth's Probation Officer (PO), the Detective (D1), and the Youth (Y1). LPA attempted to interview the alleged staff perpetrator (S1) but was unsuccessful. It was alleged that a staff member had an inappropriate relationship with a minor. (Report continued on LIC 9099-C). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Brittany Crass LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA CRISIS RESOLUTION CENTERFACILITY NUMBER: VISIT DATE: 04/17/2025

met_with: Connie Treacy


summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPA) Cindy Johnson and Uchenna Ajaero made an unannounced required annual inspection on 3/29/2022 at 10: AM. During the inspection LPAs met with Daryl Morales, Facility Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection or provided during the inspection: · Annual fees are current, but due on 4/2/2022. · Accreditation with CARF, expires 10/31/2022 · Personnel Roster/ LIC 500, Facility Sketch, LIC 308, 309, and 610C, and Board Meeting Minutes. LPAs Johnson and Ajaero conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection was 3 staff to 0 clients (due to the one youth being in school). The following was inspected and/or reviewed: I. Physical Plant Updated license was posted; Personal Rights and Activities calendars were posted. Facility telephone is working. All combined carbon monoxide and smoke detectors were tested and work. Fire Extinguishers were inspected on 2/2/2022. First Aid Kit was fully stocked. Medications were centrally stored, locked and inaccessible to clients. Office is locked and provides privacy. Laundry Facilities are available and operable. Disinfectants/Cleaning solutions are inaccessible and stored in the office and detached garage. Facility is free of vermin. Kitchen- Refrigerator Temperature was slightly below 45 degrees F. Freezer Temperature appeared to be -5 degrees. Adequate nonperishable foods were present for at least one week and fresh perishable foods two days minimum. Hot water temperatures ranged between 105-120 degrees F at three locations Menu was present and posted. Dining area has enough seating and furniture in good condition. Bathroom- 2 bathrooms (1 for clients and 1 for staff) Toilets, sink, bath and shower fixtures in good repair with no visible leaks. Adequate supply of soap and paper towels. Bedrooms- 3 bedrooms All bedrooms had the required linen, bedding and furnishings, which were in good repair. Common Room available has enough seating, furniture in good condition, not broke or damaged. Facility does not have any facility vehicles. Staff do not normally transport clients. Detached garage is kept locked and was inspected. II. Operations- Board Meeting Minutes were provided. III. Disaster Preparedness- Disaster and mass casualty plan was updated and available. Drills are conducted and documented monthly. Disaster preparedness supplies were verified. IV. Emergency Intervention- NA, not utilized. V. Clients- One client is currently placed. The one client was interviewed and file reviewed. VI. Staff- 2 staff were interviewed.

met_with: Daryl Morales, Adminsitrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced required annual inspection on 4/12/2022 at 1: PM. During the inspection, LPA met with Daryl Morales, Facility Administrator and Alice McGarvey, Facility Administrator Assistant who assisted with the inspection. Three staff were present at the beginning of the inspection and no clients are currently placed. The following items were reviewed for compliance during the inspection: V. Clients- This facility is a Crisis Resolution Center that assist in stabilizing clients and are typically in placement for 15-30 days. Parents of Clients continue to be their authorized representatives. Due to this type of program, client files meet the needs of this population, but are different from other standard child welfare placements. No violations were identified in the clients records. VI. Staff- The remaining 2 of 4 staff were interviewed and 4 files were reviewed. Administrator Certificate expires 11/15/2022. All four staff members had the appropriate criminal record clearances, current first aid & CPR certificates and valid drivers' licenses. LIC 9108 & 9052 were all signed and copies were present in the files. The four staff have varied amounts of training due to their varied length of employment. Yet, none were determined to be in violation or delinquent in training hours. VII. Core/Therapeutic Services- Trauma-Informed practices are implemented as needed. Viii. Special Health Care Needs- NA An exit interview was conducted with Alice McGarvey, Facility Administrator Assistant and a copy of all reports were provided via email. No violations were identified.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Mary Shelton made an unannounced annual inspection on 1/28/2025 at 10: AM and met with Connie Treacy, Case Manager who assisted with the inspection. LPA did advise the agency that the inspection is being completed with the use of the CARE Tool. LPA Shelton conducted a walk-through of the home inside and out. The house is under construction and there were no clients or staff present during the Physical Plant Inspection. This facility is a Crisis Resolution Center that assist in stabilizing clients and are typically in placement for 15-30 days. Parents of Clients continue to be their authorized representatives. Due to this type of program, client files meet the needs of this population, but are different from other standard child welfare placement's. However, due to the home being under construction there are no staff or clients placed in the home. LPA Shelton inspected and/or reviewed the following: · Postings of facility license and Personal Rights Poster were appropriately posted. · Carbon monoxide detectors and Smoke Detectors were present. · Common Room (living room) was available and under construction. · Dining area with enough seating for clients in care and under construction. · Two bathrooms were clean and in working order. . LPA observed Locked Facilities included a shed with equipment and other items. The following items were reviewed for compliance in the regional office prior to the facility inspection: Administrator Certificate for Connie Treacy is current and verified. Fees due were discussed and due on 4/2/25. 024. No citations were issued to the agency at the conclusion of the inspection.

met_with: Connie Treacy, Case Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, April 17th, 2025, Licensing Program Analyst (LPA) Brittany Crass arrived unannounced at the Facility for a Case Management inspection. LPA met with Connie Treacy who assisted with the inspection. On January 9th, 2025, LPA Crass received an incident report, and it was revealed that the Facility had temporarily transferred this location to their Rocklin location, because of repairs needing to be done on the Facility. The Administrator Supervisor stated he thought he had notified the Department, however upon record review, discovered he had accidentally forgotten to include Community Care Licensing in the email. A Type B citation is being given today for a violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article Continuing Requirements, Section 80078(b), Responsibility for Providing Care and Supervision on the attached LIC D page. Exit interview conducted with Administrator Connie Treacy. A copy of this report and appeal rights were given.


facility_name: KOINONIA CRISIS RESOLUTION CENTER - ANTELOPE

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 3/2/2022 at 10: AM. During the inspection LPA met with Jenna Schreader, Facility Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection or provided during the inspection: · Annual fees are current · Administrator Certificate for: Jenna is valid thru 10/26/2022 · Accreditation with CARF, expires 10/31/2022 · Personnel Roster/ LIC 500, Facility Sketch, LIC 308, 309, and 610C, LPA Johnson conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection was 3 staff to 4 clients. The following was inspected and/or reviewed: I. Physical Plant Updated license was posted; Personal Rights and Activities calendars were posted. Facility telephone is working. All combined carbon monoxide and smoke detectors work. Fire Extinguishers were inspected on 8/17/2021. First Aid Kits were fully stocked. Medications were centrally stored, locked and inaccessible to clients. Office is locked and provides privacy. Laundry Facilities are available and operable. Disinfectants/Cleaning solutions are inaccessible and stored in the staff bathroom. Facility is free of vermin. Kitchen- Refrigerator Temperature was slightly below 45 degrees F. Freezer Temperature appeared to be -5 degrees. Adequate nonperishable foods were present for at least one week and fresh perishable foods two days minimum. Hot water exceeded 120 degree F and had proper posting, labeling it over 125 degree F. Menu was present and posted. Dining area has enough seating and furniture in good condition. Bathroom- 3 bathrooms (2 for clients and 1 for staff) Hot water exceeded 120 degree F and had proper posting, labeling it over 125 degree F. Toilets, sink, bath and shower fixtures in good repair with no visible leaks. Adequate supply of soap and paper towels. Bedrooms- 3 bedrooms All bedrooms had the required linen, bedding and furnishings, which were in good repair. Master bedroom has one exterior door that does not open and is not considered an exit, which was included in the fire clearance. Common Room available has enough seating, furniture in good condition, not broke or damaged. Facility does not have any facility vehicles. Staff do not normally transport clients. Exterior shed in the backyard is kept locked and was inspected. II. Operations- Board Meeting Minutes were provided. CQI Evaluation was discussed. III. Disaster Preparedness- Disaster and mass casualty plan was updated and available. Drills are conducted and documented monthly. Disaster preparedness supplies were verified. IV. Emergency Intervention- NA, not utilized. V. Staffing- Number of Staff files reviewed - Criminal record clearances verified; First Aid Certificate; Certified Administrator certificate valid & current- 10/26/ Job title/qualification verified; Hours and Hours of required training verified. An exit interview was conducted with Jenna Schreader, Facility Administrator and a copy of all reports was provided via email.

met_with: Jenna Schreader, Facility Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 3/7/2022 at 10: AM to complete the annual inspection. During the inspection LPA met with Jenna Schreader, Facility Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection or provided during the inspection: I. Staffing- Number of staff interviewed - II. Client Records Number of Clients files reviewed- 5; Parents are the authorized representatives for the clients; Needs and Services Plan are called "Resident Assessment"- plans were discussed on obtaining the required signatures. Centrally Stored Medication and log was reviewed; Psychotropic Medication and log was reviewed; Facility does not provide allowance to the clients. Facility was not aware of the Compatible Assessment requirement, but will include it in their intake process. Number of clients interviewed III. Core/Therapeutic Services Trauma Informed Practices are implemented as needed. An exit interview was conducted with Jenna Schreader, Facility Administrator and a copy of this report was provided via email.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Mary Shelton made an unannounced annual inspection on 2/4/2025 at 9: AM and met with Katie Danner, Administrator, who assisted with the inspection. LPA did advise the agency that the inspection is being completed with the use of the CARE Tool. LPA Shelton conducted a walk-through of the facility inside and out with Toma Paskal, Youth Counselor. There was one client present during the inspection. LPA observed three bedrooms with two beds in each room. Two bathrooms with hot water, soap and paper towels for clients in care. LPAS Shelton inspected and/or reviewed the following: · Postings of facility license and Personal Rights Poster were appropriately posted. · Disinfectants/Cleaning solutions were inaccessible and locked as required. · Refrigerator Temperature was in compliance. · Nonperishable Foods for one week and fresh perishable for foods two days minimum were present. · Menu was present and posted. · LPA observed a working telephone on the premises. · Carbon monoxide detectors and Smoke Detectors were present. · First Aid Kit was present and fully stocked as required. · Common Room (living room) was available as was a therapy room for privacy. · Dining area with enough seating for clients in care was present and in good condition. · Medication was centrally stored, locked/inaccessible. Centrally stored medication and log reviewed. Cont. ·LPA reviewed (3) three staff files and (1) client file as well as conducted interviews with three (3) staff and (1) client. · LPA observed Locked Facilities included a shed with lawn equipment and other items. · Board Minutes were reviewed. · Disaster Preparedness was updated and available for review, quarterly drills are completed and logged in a binder and there are disaster preparedness supplies available and verified by LPA. · Staff training was in compliance. · Criminal record clearances were verified by LPA and in compliance. · Staff files reviewed had First Aid Certificates and CPR cards with a valid date as required. · Certified Administrators certificate was valid and current. · Staff job titles/qualifications were verified along with the required Hours of initial training. · Facility is free of vermin. · Disinfectants/Cleaning solutions are inaccessible and stored in the staff bathroom. The following items were reviewed for compliance in the regional office prior to the facility inspection: Administrator Certificate for Katie Danner is current and verified. No Fees are due at this time. LPA requested the following document LIC 500 as part of the annual review: No citations were issued to the agency at the conclusion of the inspection.


raw_content:
Narrative:
Law enforcement viewed the facility footage for the time frame and did not see evidence of any sexual interaction and staff members were providing close supervision. LPA Johnson viewed/ scanned 22 hours of facility video footage. However, due to gaps in the video footage, it cannot be confirmed whether sexual interaction occurred and determine the level of supervision provided. Y1 would not answer any questions regarding the allegation; and Y2 was not available to be interviewed. Based on the investigation, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Investigation Findings:
13Licensing Program Analyst (LPA) Cindy Johnson conducted an unannounced complaint investigation inspection at the above facility on 6/29/2022 at 3: PM with Diana MacNeill, Facility Administrator. LPA Johnson spoke with Ms. MacNeill to deliver findings of the complaint investigation of the allegations stated above. LPA Johnson informed Ms. MacNeil this case was investigated by LPA Johnson. The investigation included: the initial 10-day complaint investigation inspection was conducted on 2/17/2022 which included: interviews with the Facility Administrator and two additional staff members and obtained the client roster. A subsequent inspection occurred on 2/23/2022 to obtain an external hard drive of facility video footage and interview one youth. Facility incident report was received. Interviews were conducted with facility administrator, S1, S2, and Youth 1 (Y1) from 2/17/22- 2/23/22. Consent to interview Y2 was not successful (see LIC811 dated 6/29/2022). Sacramento Sheriff Report was obtained. The allegation is whether staff did not prevent inappropriate sexual interaction between minors, Y1 and Y2. Staff were aware both youth made emotional statements to one another, but not aware any physical touching occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Cindy Johnson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 06/29/2022

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

met_with: Diana MacNeill, Facility Administrator


raw_content:
Narrative:
The Department has investigated the complaint that staff speak inappropriately to youth in care. During, confidential interviews C1 stated that S1 did not speak inappropriately or yell at C1. Both clients and staff that were interviewed stated that S1 or other staff does not yell or speak inappropriately to clients in care. Staff does intervene when a telephone conversation upsets a client and ask, they end the call until the client can regain their composure. C1 did not recall being harassed by S1 or any staff or being asked to end a call with C1's bio-mom. C1 stated that C1 was not being harassed by anyone in the home. Based on the investigation, observation, records reviewed, and interviews conducted, the complaint findings are UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No title 22 regulations were cited during today's inspection. A copy of this report and appeal rights were given to the home.

Investigation Findings:
13Licensing Program Analyst (LPA) Mary Shelton conducted a visit to the home on 6/10/2024 at 12:10PM, and LPA spoke with the Facility Administrator Assistant to deliver findings of the investigation on the complaint allegation as stated. LPA Shelton informed the complaint investigation included a tour of the home on 3/16/2024. The initial 10-day complaint inspection was conducted by LPA Mary Shelton, at the home on 3/16/2024 which, included obtaining of relevant documents: Needs and Services Plans for the clients, any incident reports for the clients. For the Staff, LPA Shelton requested copies of their training records. A copy of LIC 500 and a list of youths placed in the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Mary Shelton LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 06/10/2024

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

met_with: Terri Anderson-Chavez, Facility Administrator Assistant


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Confidential interviews revealed conflicting information as to whether what was dropped was a THC gummy, or a sexual enhancement drug. S6, the staff member who confiscated the package, stated it said "THC" on it, and felt like there was a gummy texture inside. S5, who is the staff member that dropped the item, stated it was BlueChew, a sexual enhancement pill, only prescribed for adults 18 and over. It was confirmed by all staff interviewed, that the staff member had brought a drug to work and did not realize it fell out of his bag, which allowed a minor to have access to the item. S5 stated, "I have no idea how it fell out of my bag". This Department has investigated the allegation that a Facility staff allowed minor to have access to THC edibles. Based on interview, we have found that the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type A citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 07, Section 80087(g) Buildings and Grounds, is being cited on the attached LIC 9099D. An exit interview was conducted with Terri Anderson. A copy of this report, and appeal rights were given.

Investigation Findings:
13On Thursday, February 6th, 2025, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced complaint investigation inspection at the Facility, to deliver findings for the allegation listed above. LPA met with Terri Anderson, who assisted with the inspection. LPA Burgess conducted the initial-10 day complaint investigation at the Facility, on 12/18/2024. Between 12/18/24 and 2/4/25, LPA interviewed the Administrator (S1), Administrator's Assistant (S2), and five staff members (S3-S7). The minor was not interviewed as they have graduated from the program. It was alleged that on 12/4/2024, a staff member unknowingly dropped a small package which contained a THC gummy. It was alleged that a minor in the program picked up the package, asked what it was, and handed it to a different staff member, who confiscated it. (Continued on LIC 9099-C). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Brittany Crass LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 02/06/2025

met_with: Terri Anderson


raw_content:
Narrative:
knowledge. During confidential interviews conducted, it was determined that youth, when they go outside on facility grounds for space or leave the facility during unauthorized absence(s), do find objects they can hide on their persons and return to the facility to cause self harm. While the facility does a superficial search of youth when returning from unauthorized absence(s) and do provide close supervision, youth are still successful in bringing in items without staff knowledge. The allegation related to supervision also indicates that due to the house recently switching from a one gender facility to gender-neutral, that the supervision would be negligent, allowing for additional issues related to youth interactions. During the course of the investigation, it was revealed that youth in care did engage in an inappropriate activity but staff denied this was due to a lack of supervision. Youth involved in the identified incident were not available to speak to licensing related to this incident. Regarding the allegation related to staff sharing other youths' information with youth in care, this is related to youth and staff having discussions about previous youth who were residents of the facility. Confidential interviews indicated that staff were good about keeping discussions about current youth away from the general population and refusing to discuss previous youth with current youth in care. It was further indicated that when youth brought up other youth for comparison, staff refuse to discuss personal information about other youth with youth in care and are trained to deflect these types of interactions. LPA Hill could not corroborate personal information was being discussed in the facility as reported. As a result of the information obtained, documentation received, and confidential interviews conducted, the allegations that staff did not ensure sharps are inaccessible, staff was not proving adequate supervision, and that staff were sharing other youths' information are UNSUBSTANTIATED at this time meaning that while the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview was conducted with Ms. Anderson and documentation was provided, along with appeal rights.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill conducted a complaint inspection on 7/3/25 at 12: PM and met with Terri Anderson, Administrator to deliver findings on the complaint allegations as stated. LPA Hill informed NAME that the complaint investigation included an initial inspection to the facility on 4/15/25 where documentation was obtained including client roster, youth who had left the facility within the previous 60 days, Needs and Service Plans, and conducted interviews with youth present. Subsequent inspections were conducted on 6/5/25 and 6/6/25 where additional interviews were conducted. LPA Hill also contacted previous youth and/or their parent/guardian regarding experience(s) while residing in the facility. The allegation that staff did not ensure sharps are inaccessible and staff not proving adequate supervision are related to the youth in care having access to sharp items that they were using to self harm without staff UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 07/03/2025

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

met_with: Terri Anderson, Administrator