raw_content:
Narrative:
Confidential interviews conducted during the investigation did not yield evidence to corroborate the allegation. The investigation did not yield any other evidence that indicated that the alleged event occurred. Based on a lack of evidence, the allegation that facility staff sedated a minor while in care, may have occurred, however, it is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report was provided to Portia Tresvant, Administrator.

Investigation Findings:
13On July 24, 2024, at 1: PM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Portia Tresvant, Administrator to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on February 12, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed five staff (S1-S5) and one client (C2). LPA attempted to interview Client 1 (C1), however, C1 is non-verbal. On February 7, 2024, Community Care Licensing (CCL) received an allegation that facility staff sedated a minor while in care.It was reported that S1 sedated C1. It was alleged that, in response to behaviors exhibited by C1, S1 gave C1 a medication and 10-15 minutes later C1 began to appear drowsy and went to their bedroom to lie down. It was also reported that C1's 2:1 staff (S3 and S4) were inside the bedroom with C1 when S1 went into the bedroom, reached over to check C1's pulse, and informed S3 and S4 that S1 sedated C1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 07/24/2024

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0


state: CA

facility_name: YAI MORRO RD. EBSH

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews further indicated that while both staff were away from the facility, the facility would be out of ratio, as there would be one staff for each client instead of two staff for each client, as required. Based on confidential interviews and record review, the allegation that facility operated out of ratio is SUBSTANTIATED because the preponderance of evidence has been met. This posed a potential Health, Safety, or Personal Rights risk to children in care. The facility will be cited for violating Title 22, Division 6, Chapter 1, Article 06. Continuing Requirements, Responsibility for Providing Care and Supervision 80078(a), [See LIC 9099D]. The facility is being issued a civil penalty for the repeat violation of the above noted standards. An exit interview was conducted, and a plan of correction was developed with Portia Tresvant, Administrator. A copy of this report, LIC9099D, LIC421 and appeal rights were provided to Portia Tresvant, Administrator. The investigation did not yield evidence to corroborate the allegation that staff engaged in inappropriate behavior in the presence of a minor. Based on confidential interviews, the allegation may have occurred, however, it is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report was provided to Portia Tresvant, Administrator

Investigation Findings:
13On July 24, 2024, at 2: PM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Portia Tresvant, Administrator to discuss the investigative findings for the allegation noted above. LPA Jauregui conducted an inspection of the facility on February 7, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed eight staff (S1-S8) and one client (C2). LPA attempted to interview Client 1 (C1), however, C1 is non-verbal. On January 30, 2024, Community Care Licensing (CCL) received an allegation that the facility was operating out of ratio. It was reported that while S1 and S2 worked on the same shifts, S1 and S2 would run errands during the shift, leaving the facility out of the required staffing ratio. A review of client records indicated that, during the day, C1 and C2 required a minimum of two to one staffing each. Confidential interviews yielded that, on multiple occasions while S1 and S2 worked on the same shifts, S1 would take S2 to accompany S1 while running errands to the pharmacy and grocery store. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 07/24/2024

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

report_type: Complaint Investigation

met_with: Portia Tresvant, Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential interviews indicated C1 and C2 were running around attempting to go out through the facility's gates. Confidential interviews indicated C1 was approved to go on a walk; however, due to C2's dangerous behavior, C2 was not allowed to go out at that time. Confidential interviews yielded C1 began hitting and spitting at S2 and, according to a staff interview, staff observed S2 closing the door on C1 leaving black marks on C1's arms. Other confidential interviews yielded there were no injuries on C1, and the black marks were caused by dirt that was on the fence and it was easily wiped off. It was stated in one confidential interview that C1 was shoved with a ukeru pad. However, there was no corroborating evidence. The allegations were denied, LPA received conflicting statements, and there were no other witnesses to corroborate the event. Based on confidential interviews, the allegation that staff inappropriately handled a youth in a rough manner while in care and staff hit a youth while in care may have occurred, however, the allegations are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were was provided to Portia Tresvant, Administrator.

Investigation Findings:
13On August 8, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Portia Tresvant, Administrator to discuss the investigative findings for the allegations noted above. LPA Jauregui conducted an inspection of the facility on March 6, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed five staff (S1-S5) and one client (C1). LPA attempted to interview C2; however, C2 is nonverbal. On March 1, 2024, it was reported to Community Care Licensing (CCL) that staff inappropriately handled a youth in a rough manner while in care and staff hit a youth while in care. It was reported that S2 was allowing C1 to take a walk if they wanted to, C1 became aggressive towards S2, and S2 closed the door on C1. Confidential information received also indicated that C1 was hit by S2, and C1 was observed to have a scrape and black marks on C1's arms. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 08/08/2024

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
C1 was transported from the facility to a local hospital, at which time C1 was admitted into the hospital on a 5150 hold. It was reported that on 2/22/24, C1 met with the hospital psychiatrist, and the 5150 hold was discontinued, as it was determined that C1 did not need to go to a psychiatric hospital. It was reported that on 2/22/24, S2 was informed that C1 was ready for discharge, and S2 refused to pick up C1 from the hospital. Confidential interviews indicated the facility was not comfortable to pick C1 up from the hospital due to C1's dangerous behavior. Confidential interviews indicated that facility staff were waiting for a referral for C1 to be transferred to the hospital or for C1 to be reassessed. However, C1 was unable to be transported to the hospital due to the termination of C1's 5150 hold. Record review indicates C1's 5150 hold was discontinued by medical personnel on 2/22/24. Although confidential interviews revealed that facility staff were present with C1 at the hospital, confidential interviews and record review indicate that C1 was not picked up from the hospital by facility staff and returned to the facility until 2/24/24. Based on confidential interviews and record review, the allegation that staff refused to pick up minor from the hospital is SUBSTANTIATED because the preponderance of evidence has been met. This posed a potential Health, Safety, or Personal Rights risk to children in care. The facility will be cited for violating Title 22, Division 6, Chapter 1, Article 03. Application Procedures, Plan of Operation 80022 (b) The plan and related materials shall contain the following: (10) Transportation arrangements for clients who do not have independent arrangements. An exit interview was conducted, and a plan of correction was developed with Portia Tresvant, Administrator. A copy of this report, LIC9099D, and appeal rights were provided to Portia Tresvant, Administrator.

Investigation Findings:
13On August 8, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Portia Tresvant, Administrator to discuss the investigative findings for the allegation noted above. LPA Jauregui conducted an inspection of the facility on March 6, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed five staff (S1-S5) and one Protective Service Worker (PSW1). LPA attempted to interview Client 1 (C1), however, C1 is non-verbal. LPA obtained C1's hospital discharge paperwork and Special Incident Reports. On February 28, 2024, Community Care Licensing (CCL) received an allegation that staff refused to pick up minor from the hospital. It was reported that on 2/21/ C1 was admitted to the hospital for a 5150 hold because C1 was running into the streets, assaulting staff, and hitting themselves. Law enforcement was called to the facility in response to C1's dangerous behaviors. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 08/08/2024

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

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
It was reported that the client, aggressively attacked two women who'd come from the direction of the facility and a scuffle ensued, during which the client and women fell to the ground. Confidential interviews indicated C1 eloped to the neighbor's property and began to bang their head on a parked vehicle on the property. Confidential interviews indicated facility staff used ukeru pads to intervene, and C1 would push the pads out of the way. Confidential interviews indicated C1 was hanging on the side view mirrors of the vehicle. Confidential interviews indicated C1 attempted to open the house door of the property. Confidential interviews indicated staff attempted to place C1 on two holds, however, staff were unsuccessful due to C1 dropping their body to the floor. Confidential interviews indicated staff used ukeru safe turn approaches to redirect C1. Confidential interviews indicated C2 remained at the facility and wanted to follow C1. Confidential interviews indicated C2 walked to the property with staff and C2 wanted to get close to C1. Confidential interviews indicated C1 spit and hit C2, and C2 responded by grabbing C1 by the hair, which resulted in C1 and C2 falling to the ground. Confidential interviews indicated there was a physical altercation; however, interviews yielded that the altercation was between C1 and C2. The investigation did not yield no evidence to corroborate the allegation that staff engaged in a physical altercation with a client. Based on confidential interviews, the allegation that staff engaged in a physical altercation with a minor in care may have occurred, however, the allegation is not supported or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Portia Tresvant, Administrator.

Investigation Findings:
13On August 15, 2024, at 10: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Portia Tresvant, Administrator to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on April 26, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed five staff (S1-S5). LPA was unable to interview C1 due to C1 being non-verbal. On April 18, 2024, it was reported to Community Care Licensing (CCL) that staff engaged in a physical altercation with a minor in care. It was reported that a client was sitting on the steps of a nearby residential property and a couple of women were with the client. It was reported that the women were trying to place ukeru pads between the client and a car that was parked on the property. It was reported that more people came over, from the direction of the facility, with ukeru pads and tried to intervene by placing the ukeru pads between the client and a the parked car. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Yai Morro Rd. EBSHFACILITY NUMBER: VISIT DATE: 08/15/2024

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0


facility_name: CASITA REAL, INC

summary: Facility Evaluation

raw_content:
Narrative:
On September 8, 2025, at 1: PM, Licensing Program Analyst (LPA) Jacob Salem met with Applicants Julianne Dautin, Jhodee Quitevis, Paul Llamoso, and Nemia Atendido at the Community Care Licensing San Diego office for a Component II orientation. LPA went over application revisions and discussed the application process prior to licensure. LPA confirmed that a pre-licensing visit will be scheduled once the applicant secures control of property, receives clearance from the fire authority, and applicantion revisions are approved by the Department. The applicants stated that renovations are complete, and that they will be conducting a walk through of the property and review of lease before obtaining control of property within the next month. A signed copy of this report was provided to Julianne Dautin.

report_type: Facility Evaluation


summary: Facility Evaluation

raw_content:
Narrative:
On May 22, 2026, at 9: AM, Licensing Program Analysts (LPAs) Jacob Salem and Suzanne Martinez met with Applicants Julianne Dautin, Jhodee Quitevis, and Paul Llamoso for the purpose of conducting a pre-licensing inspection for a Group Home for Children With Special Health Care Needs. The applicants are applying for a license for five bedridden clients age 7-17. The home is a one story residence located on a residential street. LPAs toured the home inside and out and inspected the facility's physical plant, including personal rights postings, health related services, buildings and grounds, food services, telephones, indoor and outdoor activity space, and furniture, fixtures, equipment and supplies. The home is clean, in good repair, and free from observable risks to clients health, safety, and personal rights. The home contains five client bedrooms, two client bathrooms, kitchen, open living room areas, locked nursing station where medication and client files will be kept secure, backyard and patio, and garage and staff office. The license will be posted in the front hallway upon licensure. The client bedrooms will be set up as follows: bedroom 1 sleeps one client, bedroom 2 sleeps one client, bedroom 3 sleeps one client, bedroom 4 sleeps one client, and bathroom 5 sleeps one client. Client beds are equipped with half bed rails and hoyer lifts to assist with moving. The home has a cental smoke and carbon monoxide detection system with an automatic sprinkler and closing fire doors for client bedrooms. The facility is equipped with and has tested an alternative power source to operate all functions of the facility for at least six hours. LPAs conducted the component III orientation with the applicants. Continued... ...CONTINUED The facility has demonstrated compliance with Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to Julianne Dautin, Jhodee Quitevis, and Paul Llamoso.

visit_type: Prelicensing

met_with: Julianne Dautin, Jhodee Quitevis, and Paul Llamoso, Applicants


facility_name: GUARDIAN HOME, INC

summary: Facility Evaluation

raw_content:
Narrative:
On the date above a pre licensing visit was conducted at Guardian Home by Licensing Program analyst (LPA) Les Inouye. I was met by Licensee Paul Llamoso, Cherry Ann Agravante, Tara Marie Lacanilao, Julianne Datuin, Nemia Atendido. A review of the Physical Plant was conducted including the Indoor Activity Space, Fixtures Furniture Equipment and Supplies and Outdoor Activity Space. The indoor space is an open floor plan with not hazards. The outdoor area is fee of hazards. There is a utility shed in the back yard which was secured during the visit. Kitchen was clean and non-perishable items were observed in the kitchen and additional non-perishable items were observed in the pantry. Bedrooms were observed, 5 single occupancy and a capacity of five. All rooms were appropriately furnished with additional linens was observed and adequate space for medical equipment. All chemicals and cleaning supplies were locked and secured. Smoke Alarms and Carbon Monoxide detectors, fire suppression system was observed and operating. Hot water temperature was measured at 110 degrees. Back yard -there is no pool or hot tub, yard consisted of a lawn area. The physical plant review was observed to be clean, safe, and free of hazards. The physical plant has met standards. At this time the applicant is in the process to be set up with Guardian and access with a Guardian login. Applicant will notify LPA when approved. A new revision of the Review by CCL will be completed and submitted to LPA and will be reviewed.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On the date above a Case Management visit was conducted at Guardian Home by Licensing Program analyst (LPA) Les Inouye. I was met by Licensee Paul Llamoso, Cherry Ann Agravante, Tara Marie Lacanilao, Julianne Datuin, Nemia Atendido. The visit was to discuss corrections that were requested on the last review. Detailed discussions took place on several regulations, the format of the review and the required corrections. Guardian Home and LPA have a better understanding of required corrections and a revision will be submitted to the LPA once completed.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Les Inouye contacted Paul Llamoso by phone to discuss the application status. Paul advised LPA that he is out of the country and referred LPA to discuss the application with Tara Lacanilao. Paul texted Tara's phone number. LPA phoned Tara and left a voice mail message to call LPA, Number left to call back. I was able to talk to Tara and we discussed that the submission should be in by tomorrow. 3/28/25. We also discussed the Emergency Intervention Plan and review by a certified behavior analyst. She indicated that the facility is already working with someone who provides services for their other facilities. I provided Tara with a name of a behavior analyst, I came across who is an employee with Regional Center. Just a reminder that the information in the EIP section should be included in the training, Section 24. As always if there are any questions, please do not hesitate to contact me.

met_with: Tara Lancanilao


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Les Inouye Scheduled a Teleconference with Paul Llamoso of Guardian Home to go over the latest review of the Program Statement which was returned for updates and corrections on 05/23/25. Tara Lacanilo was designated to attend the meeting. During the meeting all issues identified on the review were covered. Tips to address each issue was discussed such as a Table of classes which is easier to provide required information. Also discussed was that each class must included identified required information. Tara stated that the EIP Section was currently under review by their Behavior Analyst. LPA advised to get a expected approved return date from the BCBA and inform LPA of when the EIP section can be returned for review. Tara explained that she has a scheduled call with the BCBA and will inform LPA of the status. At the end of the meeting Tara had no further questions and the meeting ended at that time.

met_with: Tara Marie Lacanilo


summary: Facility Evaluation

raw_content:
Narrative:
A TEAMS meeting was called by Guardian Home to go over the latest Program Statement revision that was returned to Guardian Home on 7/21/25. The list of corrections was reviewed which consisted 3 sections, EIP Section 14 - Updated version deleted paragraph that had approved information in it. Asked to provide information that was previously approved. The discussion revolved around the use of CPI and or a BCBA to develop a training curriculum for staff training and the documentation for the training. Staff Schedule Section 21 - Related to missing information in Section In-service Training Section Tara expected to have the Program Statement returned to CCL with in two weeks. LPA offed to have Tara contact LPA via email, text or better call to discuss any issues. At that time the meeting ended.

met_with: Tara Lacanilo


summary: Facility Evaluation

raw_content:
Narrative:
On the date above a Case Management visit was made at the Fresno Office with Licensing Program Analyst Les Inouye and Paul Llamoso, Tara Lacanilao and Julianne Datuin to discuss and go over the last return submission to Guardian Home Inc. Which was sent back to the licensee on 08/27/25. This meeting is to discuss in detail and have a conversation on the expectations of information that is to be submitted. This has been the 12th review of the Program Narrative. The discussed Program Narrative will also be used for the latest application submission for Robinwood Home. Once the current Program Narrative is approved the Program Narrative shave be revised to update any and all information that will now be used in the Robinwood Program. The issued discussed in at todays meeting are based on the requested items submitted on 08/27/25. All issues with were addressed on 08//27/25 were discussed line by line Additional items discussed include: use of the LIC500, Section Job Descriptions. Paul will submit the Program Narrative as a complete document and a review will be completed. LPA will review submitted Program Narrative and provide feedback or approve the Program Narrative. If the Program Narrative is approved including the Emergency Intervention Plan (EIP) the EIP can be presented to the Board of Directors and a resolution can be made to approve the EIP in accordance to 84322(k). The final review will include All Section A documents and any updated documents will be requested at that time.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/23/2025, an unannounced required Post Licensing inspection was conducted by Licensing Program Analyst (LPA) Les Inouye. LPA was met by Administrator Cherry Anne Agravante. An inspection of the facility was completed and the following was observed: 1. Hot water temperature measured within appropriate range @ 118 degrees. 2. All smoke detectors appeared to be in proper working condition. 3. Clients are on g-tubes but alternative food list was posted. 4. First aid kit stocked. 5. Medications locked and centrally stored. 6. Fire extinguishers properly charged. 7. Adequate indoor and outdoor activity space and activities observed. 8. Clients have adequate clothing and storage space. 9. Adequate supply of linens observed. 10. Sharps locked up securely. 11. Per Administrator, there are no weapons at the facility. 12. There are no pets at the facility. 13. There are no bodies of water at the facility. There have been no deficiencies cited since date of license. Staff and client files were reviewed and clearances verified. Facility uses Therap Comupter documentation, for clients. Physical files of staff and client files were reviewed. Administrator confirms that the exit door to Room 1 has been reported to Brilliant Corners for maintenance. The exit door due to weather sticks and makes it difficult to open and close. Facility to notify CCL when corrected.

met_with: Cherry Anne Agravante


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Group Home Special Health Care Needs (GHSHCN) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Cherry Anne Agravante. During the course of investigating the allegation, LPA conducted interviews with staff members, Board Members and witnesses, a record review and information was obtained. Board members denied all specific allegations that would be inimical to the operation of the facility. The interviews and information obtained revealed inconsistencies to the allegation. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Facility Evaluation

raw_content:
Narrative:
On 04/30/2026, an unannounced required annual inspection was conducted by Licensing Program Analyst (LPA). LPA was met by Administrator Cherry Anne Agravante. An inspection of the facility was completed and the following was observed: 1. Hot water temperature measured within appropriate range at 110 degrees 2. All smoke detectors appeared to be in proper working condition. 3. Menu was posted. 4. First aid kit stocked. 5. Medications locked and centrally stored in the kitchen. 6. Fire extinguishers properly charged. 7. Adequate indoor and outdoor activity space and activities observed. 8. Clients have adequate clothing and storage space. 9. Adequate supply of linens observed. 10. Sharps locked up securely. 11. Per the Administrator, there are no weapons at the facility. 12. There are no pets at the facility. 13. There are no bodies of water at the facility. LPA toured the facility and inspected each bedroom 1-4. All Bathrooms, kitchen and garage storage areas were in compliance. The back yard was inspected and free of hazards, with a large lawn area, wheelchair accessible swing and a large covered patio. Storage shed was observed to be secured. Facility van was was observed to be licensed and in operating order. A second van was observed on the property, that is no longer in use and not registered. A plan for this van was discussed to have it removed from the property. There have been no deficiencies cited within the prior 12 months. Exit interview was done, issues regarding the facility, placement, clients and medical issues were discussed. At this time the Annual Inspection was completed. No deficiencies or violations were observed.

visit_type: Annual


facility_name: LIBERI HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 9/03/2024 at approximately 9: AM Licensing Program Analysts (LPAs) Tatyana Shulz, Sarina Buchannan, Zaria Turner, and Licensing Program Manager (LPM) Rosa Rodriguez made an announced visit with the purpose of conducting a pre-licensing inspection to the above facility. LPAs and LPM met with Administrator, Paul Fernandez, and a walk through of the interior and exterior was completed. Physical Plant LPAs and LPM entered from the front door into the Great Room that has 1 couch, 2 chairs, coffee table and a TV, with a closet housing their emergency food supply and water. There is a dining room with a table and 4 chairs next to the kitchen area. There are 5 bedrooms all of them equipped with 1 twin bed, 2 dressers, closet, TV, lamp, patient lift, trash cans with lids and a door with access to the backyard with an attached alarm system. Room 1 is an office area with a desk, closet, filing cabinets and the medication storage lockup. Room 2 is the multipurpose room with Big Jenga, connect 4 and have sufficient activities for clients, including books, age-appropriate toys, arts/craft materials and all furniture is in good repair. There are two full bathrooms and 1 half bathroom, with working toilets, and running warm water with a temperature of 105 degrees. The two full bathrooms are also equipped with a patient lift and there is 1 shower bed available. The backyard is gated, with ADA accessible ramps leading from each exit and room. There is a gazebo area with a table and 6 chairs. There is a generator located next to the table and the shed. The shed is stocked with chairs, tools, extra refrigerator, water, nonperishable food, storage bins, and extra cleaning supplies. On the back side of the shed the property has 14 trash bins. The facility has ordered a van to transport the clients and the information will be provided to the LPA once available. Report continues on 809-C. The following required documents were posted, Emergency Disaster Plan, Personal Rights and complaint contact numbers. Disinfectants/cleaning solutions are inaccessible to children in care and locked under the kitchen sink. Refrigerator temperature at or below 45 degrees F. Nonperishable foods one week and fresh perishable foods three days minimum. Water and fridge temperature posted on the front of the refrigerator. Sharp objects are locked in the drawer and there are containers to place leftover food. A working telephone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120-degree F. Fire Extinguishers are up to date and in working order. Toilets, wash basins and shower fixtures in good repair, there are no leaks and hot water is accessible. Soap and paper towels are available to clients. Bedroom required linen and furnishings are fully stocked. The facility is free of vermin. The generator and water valves located in the backyard area are easily accessible to clients in care. There is approximately a 5 foot L shaped fence surrounding the generator and the water valves can be easily reached from the walking path. If the population served changes those two areas will need to become inaccessible to clients. However, due to the population that the facility serves currently, the licensee will not need to be concerned with these changes, as of now. An exit interview was conducted with Administrator, Paul Fernandez and a copy of this report will be provided to the facility, the home is in full compliance.

met_with: Administrator- Paul Fernandez


summary: Facility Evaluation

raw_content:
Narrative:
On February 19, 2026 at approximately 12: PM Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit with the purpose of conducting a post licensing inspection to the above facility. LPA met with Janna Kirtley, Registered Nurse (RN), and a walk through of the interior and exterior was completed. LPA entered from the front door into the Great Room that has 1 couch, 2 chairs, coffee table and a TV, with a closet housing their emergency food supply and water. There is a dining room with a table and 4 chairs next to the kitchen area. There are 5 bedrooms, all of them equipped with 1 twin bed, 2 dressers, closet, TV, lamp, patient lift, trash cans with lids and a door with access to the backyard with an attached alarm system. Room 1 is an office area with a desk, closet, filing cabinets and the medication storage lockup. Room 2 is the multipurpose room with sufficient activities for clients, including books, age-appropriate toys, arts/craft materials and all furniture is in good repair. There are two full bathrooms and 1 half bathroom, with working toilets, and running warm water with a temperature of 116 degrees. The two full bathrooms are also equipped with a patient lift and there is 2 shower beds available. The backyard is gated, with ADA accessible ramps leading from each exit and room. There is a gazebo area with a table and 6 chairs. There is a generator located next to the table and the shed. The shed is stocked with tools, an extra refrigerator, water, electric appliances, storage bins, and extra cleaning supplies. There is a Ford Transit in good repair available to transport clients. Report continues on 809-C. The following required documents were posted, Emergency Disaster Plan, Personal Rights and complaint contact numbers. Disinfectants/cleaning solutions are inaccessible to children in care and locked in the laundry area and under the kitchen sink. Refrigerator temperature is at or below 45 degrees F. With the temperature log posted on the front of the refrigerator. Food menu is posted. Nonperishable foods one week and fresh perishable foods three days minimum. Sharp objects are locked in a drawer next to the oven. A working telephone is available at the facility. First Aid Kits are fully stocked. Hot Water is between 105-120 degree F. Fire Extinguishers are up to date and in working order. Toilets, wash basins and shower fixtures are in good repair, there are no leaks and hot water is accessible. Soap and paper towels are available to clients. Bedroom required linen and furnishings are fully stocked. The facility is free of vermin. LPA reviewed 5 staff files and 3 client files, there is no Care Tool available for this facility and inspection type. An exit interview was conducted with Jennifer Kennedy, RN and a copy of this report will be provided to the facility, the home is in full compliance.

met_with: Jennifer Kennedy- Registered Nurse


facility_name: ROBINWOOD HOME

summary: Facility Evaluation

narrative: On the date above a Case Management visit was made at the Fresno Office with Licensing Program Analyst Les Inouye and Paul Llamoso, Tara Lacanilao and Julianne Datuin to discuss and go over the last return submission to Guardian Home Inc. Which was sent back to the licensee on 08/27/25. This meeting is to discuss in detail and have a conversation on the expectations of information that is to be submitted. This has been the 12th review of the Program Narrative. The discussed Program Narrative will also be used for the latest application submission for Robinwood Home. Once the current Program Narrative is approved the Program Narrative shave be revised to update any and all information that will now be used in the Robinwood Program. The issued discussed in at todays meeting are based on the requested items submitted on 08/27/25. All issues with were addressed on 08//27/25 were discussed line by line Additional items discussed include: use of the LIC500, Section Job Descriptions. Paul will submit the Program Narrative as a complete document and a review will be completed. LPA will review submitted Program Narrative and provide feedback or approve the Program Narrative. If the Program Narrative is approved including the Emergency Intervention Plan (EIP) the EIP can be presented to the Board of Directors and a resolution can be made to approve the EIP in accordance to 84322(k). The final review will include All Section A documents and any updated documents will be requested at that time.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Les Inouye travelled to the facility listed above to conduct a prelicensing inspection. The application, Plan of Operation and Program statement are under review. Corrections were requested from the licensee. Licensee is in conference with CVRC for the use and placement options. Licensee will notify CCL is there is to be a change in license. 1. Facility Grounds are clean and free of debris or observable hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locke\able and centrally stored medications location was observed. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual hospital beds were observed in good repair, with clean mattresses and pillows observed. Individual beds were observed with appropriate clean linens. Adequate supply of additional bedding and linens observed. 8. The house is a 5 bedrooms, single occupancy located on a single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods to be in place prior to accepting clients. 10. Weekly menu posted and accessible to clients. 11.Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has 2 full bathrooms in the house for client use, both are operable with roll in shower 13. Appropriate forms posted in view of facility clients. 14.Facility has no pool . 15.No firearms or weapons are allowed in the facility. Issues to be corrected 1.Water heaters on both side the house shall be secured. 2. exterior floor plan to be updated to include fenced area next to garage 3. Evacuation map to be updated to include fenced area next to garage.

met_with: Paul Llamoso, Stacyrae Agusto, Nemia Atendido, Kaycee Huertas


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Leslie Inouye initiated an inspection at the Group Home (GH) and met with Paul Llamoso. The purpose of the inspection was to follow up on information to be corrected at the Prelicenisng Inspection. LPA reviewed water heater enclosures on both sides of the house and the back yard facility sketch and evacuation map. LPA reviewed enclosures and walked through the issues of the yard facility sketch and evacuation map. Based on information reviewed locks will be installed on the water heater enclosures and a gate from between the garage and the evacuation gate exiting to Robinwood Lane will be added on the map. Pictures of the water heater locks will be submitted and revised yard sketch/Evacuation map will be emailed for review. Once these issues are addressed the application will be reviewed for approval. Licensee will be notified after final review.

met_with: Paul Llamoso


facility_name: 2 LOVING HEARTS

summary: Facility Evaluation

raw_content:
Narrative:
On August 23, 2023, Licensing Program Analyst (LPA) Demetris Teal and Licensing Program Manager (LPM) Tira Logan-Shanks conducted a Component II- in person meeting at the Monterey Park Regional Office. The following was present; Terrobin Phillips President of Loving Hearts facility. LPA and LPM discussed their application and program statement advising of the following corrections. The following information must be completed and submitted to Licensing: Section A Board of Resolution Authorizing Individual(s) to applying on behalf of the Board of Directors: who is Deesha Inc? Who are the members of Deesha Inc.? Who was present for the vote on March 1, 2023, where it was decided that Terrobin Phillips is authorized to represent and act on behalf of Loving Hearts? Why doesn't it say Loving Hearts LLC as the "members"? LIC 308 lists "TBH" as the person designated in the absence of the facility administrator. A name needs to be specified. LIC 309 list a president as N/A, yet the board of resolution names a president. Statement of Information on the Secretary of State website shows Keisha Law as a Manager or Member, but she is not listed on the LIC 309. LIC 400 needs a signature. Articles of Organization is not submitted. LIC Surety Bond needs to list LLC as the applicant. Continued... .....Continued LIC Personnel Report needs to be completed. D signed by Terrobin Phillips is not for Community Care Licensing (CCL). C is needed. 9282 signed by Terrobin Phillips is not for Community Care Licensing (CCL). LIC Health Screening Report needs to have the updated T.B tests. Program Statement needs to be followed per CCL template. Administrator currently has full time employment outside of the Group Home setting. Application shows proof of Adult Care Certification only. Discussed with president what is required for the Program Statement in detail. Program Statement details regarding tabs and information, where to look for Title 22 regulations, Interim Licensing Standards and make sure the Program Statement coincides with all regulations. President agreed to submit all information discussed and required by September 1, Exit interview conducted. A signed copy of this report was provided to the applicant along with Notice of Incomplete Application.

met_with: Terrobin Phillips


summary: Facility Evaluation

raw_content:
Narrative:
On October 3, 2023, Licensing Program Analyst (LPA) Johanna Lofton conducted an announced visit at Loving Hearts Group Home with the purpose of conducting a pre-licensing inspection. This facility will accommodate Regional Center Clients between the ages of 11-17. LPA Lofton met Facility Administrator Terrobin Phillips and Facility Manager Kiesha Law and together conducted a walk through of the facility. The facility is a one level house located in a residential area. The facility consist of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining room, garage and backyard. The master bedroom will be used as an office which is equipped with a desk, computer and office supplies. The other two bedrooms are for the clients. These bedrooms are equipped with two (2) full beds each, dressers and closet space. At the time of the inspection, all utilities (gas, water, electricity) were on. The fire alarm was tested and it was in working conditions. LPA Lofton observed nonperishable food in the fridge, freezer and pantry. There is a fire extinguisher located in the kitchen by the door leading to the backyard. Additional linen and an extra refrigerator/freezer were observed in the garage along with washer and dryer. There is a cabinet in the garage which will contain: sharps, cleaning supplies and anything toxic that will pose a risk to the clients. This cabinet will be kept locked at all times. LPA observed the outdoor of the home to be clean and free of debris and/or obstructions. There is a fully stocked first aid kit located in the office area. There were no corrections observed to be made prior to the facility being licensed. Exit interview was conducted and a copy of this report was emailed to the above mentioned administrator.

met_with: Terrobin Phillips- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 2, 2024 at 11: A.M.., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Post Licensing visit at the above named facility. LPA met with Kaiesha Law- Facility Manager. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 12 to 17. The facility serves ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There are currently no clients or staff at the facility. The LPA requested the following: Board of Director Meeting Minutes. The facility is a single-story home with 3 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with one (1) toilet in each. There are no firearms or ammunition in the facility. There are no bodies of water on the facility premises. At 11: P.M., LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a cabinet located in the garage. Sharps/knives are inaccessible and stored in a locked cabinet in the kitchen. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked cabinet in the kitchen. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. Room temperatures are maintained at 75 degrees F. The hot water temperature was tested and measured at 110 degrees F. All sinks, showers and toilets are in working order. No children are in care. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Continued.... ...Continued Adequate supply of beddings and linens were observed. Overall, facility is clean, safe, sanitary and in good repair. Operations There are no clients or staff at the facility. The board of directors are not currently conducting meetings. and will start to meet month. License is posted in a prominent location Disaster Preparedness Plan Facility maintains a current 610C. Written disaster and mass casualty plan of action will be provided and available at the facility. There are currently no clients or staff at the facility Emergency Intervention Plan Facility does not use manual restraints. Facility manager and administrator have not had restraint training and will take classes. There are currently no clients or staff at the facility Client Records There are currently no clients in care Staff Records There are currently no staff at the facility. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (1) staff. Citations were issued during this inspection.

met_with: Kaiesha Law-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On October 15, 2024, at 12: P.M. Licensing Program Analyst (LPA) made an unannounced case management visit to the above named facility. Purpose for the visit was to follow up and review TA's and TV's issued from the post licensing inspection conducted on August 2, 2024. LPA reviewed TA HSC 1565(f): HSC 1565(f)(2)(C) and found this to be completed HSC 1565(f)(2)(D) and found this to be completed CCR 80023(a) was found to be complete. CCR 84063(a)(10) was found to be complete. CCR 84063(a)(9) was found to be complete. CCR 84087(a)(4) was found to be complete. CCR 84088(j) was found to be complete. CCR 84072.2(a)(3) was found to be complete. Administrator will reprise the form with accommodating language for youth in care. Copy of the 809 was left with Administrator including appeal rights. No citations were issued. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On March 19, 2025 at 1: P,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met withTerrobin Phillips-Administrator. The facility currently has a provisional Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 12 to 17. The facility serves ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There is currently one (1) client in placement. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 3 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water in the facility premises. At 1: P.M.,LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked staff office. Sharps/knives are inaccessible and stored in a locked staff office cabinet. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked staff office cabinet . Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 115 degrees F. All sinks, showers and toilets are in working order. No more than one (1) children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. continued..... .....continued Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is the responsible and capable staff for communicating with emergency personnel in the facility. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster and fire drills are conducted monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Emergency Intervention Plan Facility does not use manual restraints. However, all staff (2) members are trained on emergency intervention procedures. Client Records LPA reviewed one (1) client record. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. Current client has been in the home for less than a month. Medical records have been requested and will be updated by Regional Center Staff LPA interviewed one (1) client in care. Continued..... ....continuation Staff Records LPA reviewed two (2) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. The administrator meets the required qualifications and/or experience. Documentation of the required education and experience will be sent to LPA. It was not observed at the time of the review. LPA verified at least 20 hours of annual training for Facility Manager. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (2) staff member. There were 2 citations assessed during this inspection one (1) technical advisory and three (3) technical violations. Exit interview conducted.

met_with: Terrobin Phillips-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 9, 2026 at 10: A,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met withTerrobin Phillips-Administrator. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 12 to 17. The facility serves ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There is currently one (1) client in placement. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 3 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water in the facility premises. At 10: A.M.,LPA conducted a walk-through of the entire facility. continued on page 2..... page 2....... Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked staff office. Sharps/knives are inaccessible and stored in a locked staff office cabinet. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked staff office cabinet . Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 115 degrees F. All sinks, showers and toilets are in working order. No more than one (1) child shares a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is the responsible and capable staff for communicating with emergency personnel in the facility. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster and fire drills are conducted monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Continued on page 3 page 3.... Emergency Intervention Plan Facility does not use manual restraints. However, all staff members are trained on emergency intervention procedures. Client Records There were no clients to interview. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. LPA requested Administrator to submit proof of psychotropic medicine approval from parent. Staff Records LPA reviewed three (3) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. The administrator meets the required qualifications and/or experience. LPA verified at least 20 hours of annual training for Facility Manager. LPA requested Administrator to submit proof of prudent parent training and signed staff duties/job description for one (1) out of three (3) staff. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (1) staff member. There were 3 citations assessed during this inspection. Exit interview conducted.


facility_name: A RAY OF SUNSHINE CHILDREN'S HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday February 3, Licensing Program Analysts (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Administrator Mesalina Lee-Gonzales. The facility has a census of five clients. Administrator Mesalina informed me that they are licensed for an Adult Residential Facility (ARF). They were licensed on 07/22/2021. Administrator made a copy of the license was given to LPA Ng. LPA Ng also received their Children's Residential license. An exit interview was conducted and a copy of this report was emailed to Administrator Mesalina .

met_with: Mesalina Lee-Gonzales


facility_name: ACHIEVER'S GROUP HOME

raw_content:
Investigation Findings:
13On 7/25/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Nelly Robillo, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on the report, the allegation pertains to client C1 (See LIC 811, dated 6/30/22), who sustained unexplained injuries while in care. While investigating, LPA Ng interviewed staff, case manager, and reviewed incident reports and Needs and Service Plans. LPA Valenzuela visited the facility on 6/30/22 and took pictures of (C1)'s arms. Upon review, there was two scrapes on (C1) left arm. The scrapes were ½ a centimeter in size and light brown and white in the middle. LPA Ng received an incident report dated 6/22/22, explains how C1 got the scrape, where it came from, and what immediate action was taken. Staff hugged C1 to shield them from C3, immediately separated them, treated the wound with an ice pack and antibiotics. LPA Ng found no additional cuts or bruises on client's arm. During confidential interviews from staff, (C1) got the scrapes from C3 which matches what was written in the incident report. After a review of C3's needs and service plan and talking to their case manager, C3 has a history of pinching behavior. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that minor sustained unexplained injuries while in care, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was sent to Nelly Robillo, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Nelly Robillo


raw_content:
Investigation Findings:
13On 11/3/22 at 12: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Achiever's Group Home and spoke with Nelly Robillo, Administrator. The purpose of the inspection was to open the complaint and deliver the findings for the above complaint allegations. During investigation, interviews were conducted and documents were reviewed, and it was determined that the Facility incorrectly charged resident, Facility is mismanaging resident's P & I monies, and Facility is mismanaging resident's records. Based on LPA's interview with staff, clients, and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, Facility incorrectly charged resident, Facility is mismanaging resident's P & I monies, and Facility is mismanaging resident's records is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80026(h) Safeguards for Cash Resources, Personal Property and Valuables. At this time, one deficiency was given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Nelly Robillo, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: ACHIEVER'S GROUP HOMEFACILITY NUMBER: 015650113

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


summary: Facility Evaluation

raw_content:
Narrative:
On 4/20/22 at 11: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced annual/required inspection to this location. LPA Ng came in at 11:45 and met with Administrator Nelly Robillo. Administrator informed LPA Ng that they closed the entrance gate due to the incidents of a client AWOLing (See LIC 809-C for more details).The facility is licensed for six residents, and currently in placement is 3 clients. LPA observed one client in care who is non-verbal, however appeared to be in good spirits. Client had a visitor which was her dad. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. LPA Ng toured the facility inside and out, and the facility consist of four bedrooms. Three bedrooms for clients and one for staff and all bedrooms are double occupancy and four bathrooms. Two bathrooms are located in master bedrooms which are located on both sides of the home, and two single bathrooms. The water temperature measured 105.4 degrees F. The facility is clean, safe and sanitary. The facility had sufficient perishable and nonperishable food supplies. The smoke detectors and fire extinguishers are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. ------Cont. On Lic 809c----- Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: Complaint procedures were not posted in the facility and was not accessible for staff and clients and their authorized representatives. LPA advises per CCR regulation, 84072.2(a)(3), complaint procedures must be posted in the facility within clear view of clients and their authorized representatives. LPA also gave a technical assistance regarding the entrance way. Upon arrival, LPA Ng called the facility five times due to no doorbell and locked entry way. There was no entry point or door bell to inform the facility that the LPA was here. LPA saw Administrator leaving and was able to flag Administrator Nelly down. Administrator let LPA come in to conduct the annual inspection. During Inspection, LPA Ng called the house phone and it rang. Administrator stated that they did not hear the phone. LPA let Administrator know that annual visits and all other CCL visits are unannouced and LPA's can show up at any time. Administrator informed LPA that they will install a doorbell at the gate to notify if a visitor/CCL is here. At this time, 1 deficiency and technical assistance were given. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Nelly Robillo, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/30/22 at 10: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced annual/required inspection to this location. The facility is licensed for six residents, and currently in placement is 3 clients. There were three staff present at the time of the inspection. All clients were at school at the time of the inspection. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. At 10: AM, LPA Ng toured the facility inside and out, and the facility consist of four bedrooms. Three bedrooms for clients and one for staff and all bedrooms are double occupancy and four bathrooms. Two bathrooms are located in master bedrooms which are located on both sides of the home, and two single bathrooms. All client bedrooms are currently single occupancy. The water temperature measured 107.5 degrees F. The facility is clean, safe and sanitary. The facility had sufficient perishable and nonperishable food supplies. Knives and chemicals are locked in a secure area. The smoke detectors and fire extinguishers are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. At 11: PM, LPA Ng observed the backyard with a wooden fence. There were two storage sheds on the side of the house. Both contained extra linens and decorations. There were no open bodies of water and no hazards. Their centralized AC unit was on the other side of the house and inaccessible to clients in care. All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. All medications were consistent with these records. One client is on psychotropic medication. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: ----cont on 809C---- During a review of the clients medication records, LPA Ng found that one client was taking psychotropic medication. Facility did not use a separate form for the psychotropic medication. Facility cited per CCR regulation, 84070(b)(13), under Children's Records. Please see 809D for more information. At this time, 1 deficiency was given. An exit interview was conducted, and a copy of this report was printed and given to Licensee/Administrator Nelly Robillo, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/31/2024 at 1: PM, Licensing Program Analyst (LPA) Jasmine Cardeno and Licensing Program Manager (LPM) Carolyn Flynn made an unannounced visit to Achiever's Group Home to conduct a required annual inspection. LPA Cardeno and LPM Flynn met with Facility Administrator, Nelly Robillo, who helped assist with the inspection. The Facility Achiever's Group Home has a current census of 3 clients and all clients are nonverbal. At the start of the inspection, the clients were at school and there were 4 staff present at the time of the inspection. Later, 2 clients came back home from school and greeted LPA and LPM and appeared happy, smiling at LPA and LPM. The CARE Inspection Tool was used to conduct the inspection. At the start of the inspection, LPA Cardeno and LPM Flynn conducted a walk-through of the facility, both inside the home and outside of the home. The facility is currently under construction for 1 client's bathroom. The client's bathroom is under construction to replace the flooring. LPA and LPM observed that there were construction materials and tools present on the facility grounds. When the clients were present on the facility grounds, the construction materials were removed and not made available for the clients. There are 3 bedrooms for clients and 4 bathrooms. There are 3 bathrooms for clients and each client has their own personal bathroom. All client bedrooms are single occupancy, and beds have clean linens. LPA Cardeno observed centrally stored medications maintained and locked secure in the closet located in the living room. The facility had sufficient perishable and nonperishable food supplies. The Facility Achiever's Group Home is maintained at 76 degrees Fahrenheit and the hot water temperature measures at 109.2 degrees Fahrenheit, which the temperatures are both within range. Sharps were locked in a secure cabinet under the sink of the kitchen. At 1: PM, LPA Cardeno observed that there was a sharp knife that was in a kitchen drawer and not locked away in a secure location. At this time, due to time constraints, LPA Cardeno was not able to conduct staff interviews and do further file review including the client files and staff files during this visit. LPA Cardeno discussed the following with Facility Administrator, Nelly Robillo, and issued Technical Violations: LPA observed the chemical cleaning supplies that were stored were not locked away as the garage door was open. Usually, the garage door is closed and the door to the garage storage area is locked and the cleaning supplies are locked in the location. LPA observed that there was a sharp in a drawer that was unlocked. The Facility Administrator locked away the sharp right away in the secure cabinet and explained that the knife was used during the construction. An exit interview was conducted, and a copy of this report was given to Facility Administrator, Nelly Robillo, whose signature on this form confirms the receipt. LPA Cardeno will continue this Annual Inspection at a future date.

met_with: Nelly Robillo, Facility Administrator


summary: Facility Evaluation

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Narrative:
On 07/24/2024 at 10: AM, Licensing Program Analyst (LPA) Jasmine Cardeno made an unannounced visit to conduct a continuation of the Annual Inspection for Achiever's Group Home and met with Facility Administrator, Nelly Robillo. Achiever's Group Home currently has a census of 3 clients. No client interviews were conducted, as the clients are nonverbal. At the time of the visit, 5 staff were present and 2 staff interviews were conducted. At 11: AM, LPA did a walk-through of the facility, facilitated by Nelly Robillo. LPA observed that the client bedroom that was previously under construction for the bathroom, is no longer under construction and the bathroom has been fully repaired and remodeled. Achiever's Group Home is currently not going under construction and the construction has been finished. All of the walkways are free of obstructions. LPA toured the kitchen and observed sufficient supply of food including perishable and non-perishables and observed the weekly food menu items to be posted. LPA observed centrally stored medications maintained and locked secure in the closet located in the living room area. The Facility Achiever's Group Home is maintained at 72 degrees Fahrenheit and the temperature is within range. At 11: AM, LPA checked the previous two technical violations that were cited from the visit for the initial Annual inspection. LPA observed that the cleaning supplies and materials were stored in a secure location that is not accessible to the clients and all sharps were kept locked in the secure cabinet under the sink of the kitchen. At 11: AM, LPA reviewed 3 client records and 7 staff records. LPA observed the clients records to be complete and up to date including Psychotropic Medication Administration Records. LPA observed the staff records including the Administrator's file to be complete including the CPR/First Aid Certifications, Background Check Clearances, Trainings, and other documents. At 1: PM, LPA interviewed 2 staff. An exit interview was conducted, and a copy of this report was given to the Facility Administrator, Nelly Robillo, whose signature on this form confirms the receipt


summary: Facility Evaluation

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Narrative:
On April 23, 2025 at 7:30am, Licensing Program Analyst (LPA) Monica Pavia made an unannounced inspection to Achiever's Group Home to conduct a required annual inspection. LPA Pavia met with Facility Administrator, Nelly Robillo, who helped assist with the inspection. Achiever's Group Home has a current census of 3 clients and all clients are nonverbal. The clients were at school during LPA inspection. There were 3 staff present at the start of LPA inspection. This annual inspection (including review of staff and clients files), will be reviewed at a later date. Licensee paid annual fees due, via online with PIN provided, during LPA inspection. Please update the following facility forms and submit to CCL by 5/14/25: 1. LIC308 2. LIC309 3. LIC500 4. Lic610c


summary: Facility Evaluation - 1 deficiency

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Narrative:
On May 13, 2025 at 7:30am, Licensing Program Analyst (LPA) Monica Pavia made an unannounced inspection to Achiever's Group Home to complete a required annual inspection. LPA Pavia met with Facility Administrator, Nelly Robillo, who helped assist with the inspection. Achiever's Group Home has a current census of 3 clients and all clients are nonverbal. The clients were at school during LPA inspection. There were 3 staff present at the start of LPA inspection. LPA Pavia reviewed 3 client files and 3 staff files, on above date. The following Title 22 deficiencies, Type A, were cited on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, sections 84088.3 and 80087(c). The following Title 22 deficiencies, Type B, were cited on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, sections 80087(g) and 84068.3(a). The following Technical Violation (TV) was written and reviewed on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, section 84070(b)(16). The following Technical Advisories (TAs) were written and reviewed on above date, based on LPA observations on April 23, 2025 and May 13, 2025. Title 22, sections 84072(a), 80088(f)(1) and 84064(e)(1). Copies of all reports were left with Administrator in addition to Licensee Appeals Rights explained and a copy given to Administrator.

Deficiencies:
84068.3(a): Modifications to Needs and Services Plan

(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


facility_name: ADOLESCENT GROWTH INC.

raw_content:
Narrative:
Confidential statements obtained could not corroborate the allegation. The facility client who made the initial disclosure later changed their account during the investigation denying the allegation. Other confidential statements obtained from facility clients did not provide any corroborating evidence to support the allegation. Facility staff also denied the allegation. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On December 15, 2022 at 4: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated by Community Care Licensing, Investigations Branch, Investigator Laura Garcia and LPA Rarela. During the course of the investigation, Investigator Garcia interviewed a former facility client on 10/13/22, facility staff on 10/13/22 and 10/18/22; LPA interviewed facility clients on 10/4/22, and facility staff on 10/4/22 (see Confidential Names Form dated December 15, 2022). Investigator Garcia also reviewed documents including CPS reports, facility records and incident reports. It was alleged that an unknown facility staff provided a facility client with illicit drugs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Adolescent Growth INC.FACILITY NUMBER: VISIT DATE: 12/15/2022

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

met_with: Dr. Joy Lewis, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Adolescent Growth, Inc. on March 17, 2022 at 10:20am for the purposes of conducting a Required Year inspection. LPA met with Dr. Joilyn Lewis, President/CEO and John Lewis, COO, and discussed the purpose of today's visit. The license issued by Community Care Licensing (CCL) allows the licensee to serve six ambulatory clients ages 12-17 years old. The facility is located in a residential neighborhood and has three bedrooms, three bathrooms, kitchen, living room, and dining area. LPA and the licensee toured the facility and discussed the inspection in detail. Currently, there are no clients in placement at the facility. The facility has no direct care staff as of this date but is in the process of hiring new staff. LPA observed three bathrooms to be in good repair and working order. The three bedrooms contained two twin beds in each bedroom as well as ample closet space. LPA observed adequate seating in the dining area and the living room. The smoke alarms were operable throughout the facility. There is also a classroom area inside the facility for the clients to use. LPA observed several desks and chairs in the classroom area that were arranged in a classroom style setting. There were books, board games, and arts and crafts supplies inside the classroom. . The facility does not have any clients in placement at this time nor direct care staff; therefore, no client or direct care staff files were available to review. The President/CEO stated that there were no guns or weapons on the premises. Licensee will scan LPA an updated LIC500 (Personnel Report) and a copy of their most recent Board of Director's meeting minutes. LPA found no Title 22 deficiencies on this date. Exit interview done

met_with: Dr. Joilyn Lewis,President/CEO and John Lewis, COO


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Adolescent Growth, Inc. on February 02, 2024 at 11:00am for the purposes of conducting a Random Annual inspection. LPA met with Dr. Joilyn Lewis, President/CEO (P/CEO) and John Lewis, COO, and discussed the purpose of today's visit. The license issued by Community Care Licensing (CCL) allows the licensee to serve six ambulatory clients ages 12-17 years old. The facility is located in a residential neighborhood and has three bedrooms, three bathrooms, a dining area, living room, and a kitchen. LPA and the P/CEO toured the facility and discussed the inspection in detail. Currently, there are no clients in placement at the facility. Also, the facility has no direct care staff employed at the facility as of this date. Therefore, no client or direct care staff files were available to review. LPA observed three bathrooms to be in good repair and working order. The three bedrooms contained twin beds in each bedroom and ample closet space. LPA observed adequate seating in the dining area and the living room. Smoke alarms and fully charged fire extinguishers were available at the facility as well. The P/CEO stated that there were no guns or weapons on the premises. Licensee provided LPA an updated LIC500 (Personnel Report) and a copy of their most recent Board of Director's meeting minutes. LPA found no Title 22 deficiencies on this date. Exit interview done.

met_with: Dr. Joilyn Lewis, President/CEO and John Lewis, COO


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Adolescent Growth, Inc. on February 07, 2025 at 2:00pm for the purposes of an unannounced Random Annual inspection. LPA met with Christina Tornero, Supervisor and Dr. Joilyn Lewis, President/CEO, and discussed the purpose of today's inspection. LPA and the Supervisor conducted a tour of the facility. The license issued by Community Care Licensing (CCL) allows the licensee to provide care and supervision to six ambulatory clients ages 12-17 years old. The facility is located in a residential neighborhood and has three bedrooms, three bathrooms, living room, dining area, and a kitchen. Currently, there are four clients in placement at the facility. LPA observed a fully stocked refrigerator in the kitchen. Medications, sharp knives, chemicals, and cleaning supplies are kept locked in areas inaccessible to children. The kitchen was observed to be clean and well stocked with several food items (perishable and nonperishable). LPA observed three bathrooms to be in good repair and working order. The First Aid Kit was fully stocked. LPA observed a separate classroom on the premises for the clients' educational activities. The outdoor areas were observed to be free of debris and hazards. LPA did not observe any pools or other bodies of water on the premises. LPA observed all three bedrooms with twin beds, dresser, and closet space. Files were reviewed and all were found to be in order. LPA spoke with three clients during the inspection. Each client was observed to be neat and well groomed. The last fire drill was held on December 12, 2024 at 3:00pm. LPA obtained a client roster during the inspection. Licensee will email LPA a current facility staff roster (LIC500) as well as a copy of the minutes from the most recent Board of Director's meeting. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis was advised by Licensing Program Manager (LPM) Yan Yeung to conduct a case management inspection to follow up with the facility to ensure staff noted on the most recent LIC 500 were available per the information listed on the report. LPA went to Adolescent Growth, Inc. on August 20, 2025 at 11:20am for the purposes noted above. LPA met with Verenice Perez, Medical Assistant and Bethany Moore, Academic Coordinator/Supervisor and discussed the purpose of today's visit. Individuals noted on LIC 500 are employed with the facility. Facility manager/Supervisor was present during the inspection. LPA found no Title 22/ILS deficiencies on this date. Exit interview done


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Adolescent Growth, Inc. on December 10, 2025 at 2:40pm for the purposes of conducting a case management inspection. LPA met with Dr. Joilyn Lewis, President/CEO (P/CEO) and John Lewis, COO, and discussed the purpose of today's visit. Currently, there are four clients placed at the facility. LPA randomly reviewed three staff files and found the reviewed files to be in order. LPA spoke with two clients that were present during the inspection (refer to Confidential Names form (LIC 811) dated December 10, 2025). Both clients indicated that staff treats them well and that they are getting plenty to eat. Both clients were observed to be neat and well groomed. LPA also spoke with staff during the inspection. The facility stated that they offer individual therapy, family therapy, and group therapy. Extracurricular activities are available and offered to the clients. Staff receives continuous training throughout their employment at the facility. LPA discussed cameras and the need to obtain a Program Statement Addendum Approval for the use of cameras at the facility. LPA also advised licensee that he would re-submit to them a copy of PIN 24-09-CRP Video Cameras in Children's Residential Congregate Care Facilities to provide them with information concerning video cameras. LPA found no Title 22 deficiencies on this date. Exit interview done


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis was advised by Licensing Program Manager (LPM) Yan Yeung to conduct a case management visit to cite Adolescent Growth, Inc. based on observations made by LPA Olena Maico on Friday, August 08, 2025. LPA went to Adolescent Growth, Inc. on August 12, 2025 at 12:35pm for the purposes noted above. LPA met with Dr. Joilyn Lewis, President/CEO (P/CEO) and John Lewis, COO, and informed both individuals of the citation. LPA advised the P/CEO and the COO that LPA Maico drafted the report and citation and he will present the report and citation verbatim as drafted by LPA Maico. LPA Maico's report is as follows: On 08/08/2025 at 11: AM Licensing Program Analyst (LPA) Olena Maico visited the facility during the unannounced complaint investigation and did not observe Facility Manager or Administrator on premises. During LPA's visit the staff who was at the door stated she was a Medical Assistant (MA. LPA asked if there was another staff on premises and MA stated there was also a Therapist. The MA called the Facility Manager (FM) and the FM stated she took a day off today. LPA asked if the FM or Administrator were on premises and FM said no. FM stated she will be on her way to the facility. At around 12: LPA asked MA if the FM was coming and MA stated the the FM should be here in 10 minutes. At around 12: PM the Administrator arrived at the facility and spoke with the LPA. LPA asked if the Facility Manager is scheduled to be on the premises when the children are present. Administrator stated that the Facility Manager was on premises till AM and the other supervisor also has been present. LPA was shown the video of the person sitting at the desk. LPA inquired why the contradicting information was provided to the LPA and LPA was informed that the Facility Manager was not on premises. LPA requested LIC 500 from the Administrator. LIC 500 was provided to the LPA. LPA did not observe the Facility Manager position on the LIC 500. LPA informed the Administrator that the position is required by the Title 22 and needs to be revised. Title Chapter Article 6 84065 (d) states The licensee shall designate at least one facility manager to be present at the facility at all times when children are present. LPA did not observe Facility Manager or the Administrator present at the facility at the time LPA arrived and there were 3 children at the facility at the time of LPA's visit. The Administrator did not arrive to the facility until 12:40. The facility is being cited for the violation of the section 84065 (d) Administrator. The copy of this report and LIC 809d as well as LIC 811 was provided to the Administrator. Exit interview done. Appeal Rights given


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Adolescent Growth, Inc. on November 20, 2025, at 11:45am to follow up on a Special Incident Report (SIR) that was submitted late to Community Care Licensing (CCL). LPA met with Juan Osorio, Academic Coordinator, and discussed the matter. Information shows that the incident occurred on October 16, 2025 and CCL received the report on October 20, 2025. The facility informed LPA that the late reporting occurred due to a staff error. Based on the late reporting, LPA has determined that a reporting requirement violation has occurred. Therefore, the following deficiency will be cited per Title 22 regulations (see LIC809D). Exit interview done

met_with: Juan Osorio, Academic Coordinator


facility_name: ADOLESCENT GROWTH, INC.

raw_content:
Narrative:
Staff and local police also confirmed that incidents occurred at the facility but were not properly reported and incidents were not documented on written incident reports sent to the Licensing agency. As such, specific incidents can not be evaluated for supervision requirements being met. However, incidents reported by the police to LPA do not confirm that a lack of supervision was the cause of any incident or that there was a violation related to any incident. Despite staff statements that the facility was understaffed, statements also indicate that staff did work overtime and/or step in to ensure supervision. Additionally, the facility has temporarily closed the facility, and there are no residents in care at this time. Although the allegation may have happened or is valid, based on LPA's observations and interviews with residents and staff, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. LPA is issuing one advisory, per California Code of Regulations, Title 22, Chapter 5, Section Responsibility for Providing Care and Supervision. An exit interview was conducted, and a copy of this report left with Administrator Joy Lewis.

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

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

met_with: Administrator Joy Lewis; CFO John Lewis


raw_content:
Narrative:
... Residents were left in the milieu to get ready for bed while staff went down the hall to prepare night medications. Staff returned to the milieu between 3 and 5 minutes later, but the exact time could not be confirmed. However, it was long enough for R1 and R2 to engage in sex in R1's room. Due to the known risk, there should have been enhanced supervision. The youth were separated and checked in with separately. Later, clinical staff responded and came to the facility that night. R1 was informed that this event was grounds for discharge. In response, R1 packed a bag and left the facility that night on an unauthorized absence. Based on staff interviews, R1 was not properly informed of this, triggering the leave. The police located the youth and were informed by clinical staff, as confirmed by clinical staff, that the youth could not return to the facility. R1 waited with police and then waited on the porch the next day until R1's parent could pick up R1. Staff kept an eye on the youth on the porch and provided food. However, the youth should have been encouraged to remain in the facility with enhanced supervision to keep youth separate from each other and the discharge procedures followed properly. R1 was prescribed the psychotropic medication Zoloft, AM dose, and an informed consent was signed by the parent, consenting to the administration of the medication while R1 was in the facility's care. However, it was confirmed that the medication was not administered because R1 was assessed by the facility's hired nurse practitioner, who continued the Zoloft and added additional medications, for which a new medication consent form needed to be signed by the parent(s). However, there should be no lapse in administration of medications, especially psychotropic medications. Documents and witness and staff interviews indicate that R1 was admitted on 7/14/21 and left the facility on 7/15/21. Per Administrator and CFO, R1 was assessed on 7/15/21 afternoon. The AM Zoloft dose should have been administered on 7/15/21 morning. The preponderance of evidence standard has been met, and therefore the above allegations are found to be Substantiated. LPA is issuing three citations, per California Code of Regulations, Title 22, Sections 84065. Staff/Child Ratios, 84068. Removal and/or Discharge Procedures, and Health Related Services. An exit interview was conducted, appeal rights provided, and a copy of this report left with Administrator Joy Lewis. LPA is issuing an advisory per California Code of Regulations, Title 22, Section Personal Rights and advises that the facility document when medications are transferred out of the facility at discharge similar to the documentation of medication at admission. An exit interview was conducted, and a copy of this report was left with Administrator Joy Lewis.

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

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

met_with: Administrator Joy Lewis


raw_content:
Narrative:
Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given to Facility Administrator whose signature confirms the receipt of this report.

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

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

met_with: Administrator, Joy Lewis and Licensee John Lewis


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

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

met_with: Joy Lewis - Administrator