summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On February 24th, 2025 at 10:07AM, Licensing Program Analysts (LPAs) Mona Lam and Hanako Primer conducted an unannounced annual continuation inspection to the above licensed facility. LPAs met with Administrator Michelle Hankes and Human Resources Director Zuzana Houbova. LPAs inspected facility vehicle, which was in working condition. LPAs inspected facility's emergency keys. During the inspection, LPAs continued inspecting five staff files. At this time of the inspection, LPAs were not able to observe documentation on job shadowing, administrator or administrator designee's assessment on each child care staff within 7 calendar days of completion of the 8 hour training, and documentation of on-the-job training. At this time, the following training were not observed within the staff files, but are not limited to: prudent parent standards, medication procedures, assistance with medication, universal precautions, recognition of early signs of illness and the need for professional assistance, child's right to receive sexual and reproductive health care and information, guidance about how to engage and talk with children about healthy sexual development and reproductive and sexual health, and information on current contraception methods. LPAs issued two Type B citations under: 80066(a) Personnel Records and 84065(i)(3) Personnel Requirements. Two (2) deficiencies were cited at the inspection (refer to LIC809-D) and one (1) technical violation and one (1) technical advisory were issued. An exit interview was conducted a copy of this report and appeals rights page were discussed, printed, and delivered to Michelle Hankes prior to leaving the facility.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information


state: CA

facility_name: EMBARK AT SAN MARTIN

summary: Facility Evaluation

raw_content:
Narrative:
On January 6, 2026 at 12:10PM, an unannounced annual inspection was conducted by Licensing Program Analysts (LPA's), Kaitlyn Wong and Mona Lam at the above licensed facility. LPAs met with Micki Hankes, Executive Director, who assisted with the inspection. LPAs explained the purpose of the inspection and were granted access to the facility. The facility has a capacity of six clients, ages twelve through seventeen and is currently holding a census of three. The home has three client bedrooms, each bedroom has two beds, and the home has one full client bathroom and one half client bathroom for all the youth. At the time of the inspection there were three clients in care and six staff members present. There is a dining room, a living room, classroom, and a kitchen. LPAs recorded the facility thermostat to read 69 degrees Fahrenheit. LPAs inspected refrigerator and non-perishable food storage spaces to have available food supply to meet the dietary needs of above clients and are free from contamination. LPA Wong measured the refrigerator temperature to be 40 degrees Fahrenheit, and freezer temperature to be -18 degrees Celsius. LPAs observed menu posted in Living Room with listed breakfast, lunch, and dinner plans. A written activity calendar was posted next to the menu. LPAs performed an inspection of the facility grounds and inspected storage areas of clients' personal property. LPAs observed a house phone in the classroom to be plugged in and made available for client use. Cleaning supplies and sharps were found to be in a locked storage room. Linen, hygiene, and household supplies were found to be in adequate supply. LPAs inspected a first aid kit with all required supplies. All smoke detectors were identified. LPA Wong measured bathroom hot water up to 113.5 degrees Fahrenheit. [Continued on LIC809-C] LPAs observed a fireplace in the Living Room which was accessible to clients in care. Staff informed LPAs that the fireplace is not used. LPA Wong advised that facility installs a screen or barrier that blocks the fireplace from clients, and issued a Technical Violation under 80088(c) Furniture, Fixtures, Equipment, and Supplies. LPAs inspected the backyard of the facility and found it to be in good repair. LPAs observed a pool surrounded by a see-through fence that stood at 5 feet in height. LPAs inspected facility's emergency keys and one facility vehicle, which was in working condition. LPAs inspected the client medication and medication logs, facility disaster and mass casualty plan, and emergency client files and bag. LPA Lam mentioned to staff that clients' Needs and Service plans were missing and must be included in their individual emergency client files. Staff stated that they will print and insert those plans into each client file. LPAs inspected the manual restraint logs, licensing report records, Board of Director's meeting minutes, and one staff file. LPAs observed these files to be in compliance with regulations. At this time the inspection is not complete and will be concluded at a later date. No deficiencies were cited at this time. An exit interview was conducted, a copy of this report was discussed, printed, and delivered to Micki Hankes prior to leaving the facility.

report_type: Facility Evaluation

visit_type: Annual

met_with: Micki Hankes, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On March 6, 2024 an unannounced annual inspection was conducted by Licensing Program Analysts (LPA's), Shikya Belfield and Jasmine Cardeno at the above facility at 10: Am. LPA's arrived at the facility and met with the House Manager, Alyssa Avila and HR director, Vicky Groom, Regional Executive Director Amir Rafiei. LPA's informed Embark representatives of the purpose of this visit to conduct an continuation of the annual inspection of the facility. The facility has a capacity of six clients, ages twelve through seventeen and is currently holding a census of six. The home has three client bedrooms, each bedroom has two beds and the home has two client bathrooms for all the youth. There is a dining room, a living room, and a kitchen. All smoke detectors were tested and were in working order. The fire extinguisher was prominent and is up to date based on observations at the previous inspection. During this inspection LPA reviewed five staff files and six client files. During a file review it was observed that the facility staff have not received annual training. Facility is cited for violation of the California Code of Regulations, Title 22, Division Six, Section 84065(j)(1) Annual Training. Also observed during a medication log review, the facility did not have the PMAR properly completed, facility is cited for violation of the California Code of Regulations, Title 22, Division Six, Section 84070(b)(13)(C) Children's Records. Technical Violations were issued for sections 84070(b)(13)(D), 84070(b)(13)(E), 84070(c)(1) Children's Records, as there were no signed copies of the needs and service plans by clients or their authorized person. Deficiencies described on the following page 809D. Board meeting minutes will be sent to the department by 3/11/2024 as well as staff training record for medication. An exit interview was conducted and copy of this report along with appeal rights will be sent to Alyssa Avila and Vicki Groom.

visit_type: Case Management

met_with: Amir Rafiei


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility. The purpose of this visit was to conduct an interview. LPA discussed this with Joseph Loredo, Facility Manager at 6:00 am on 2/27/25. The staff member LPA needed to interview no longer works at the facility. Exit interview was conducted and a copy of this report was emailed to Micki Hankes, Executive Director.

met_with: Joseph Loredo, Facility Manager


facility_name: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUS

summary: Complaint Investigation - Substantiated - 1 deficiency - 1 allegation

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegation. LPA met with Daniel Padron Garcia, Site superviser (SS) at 1: PM on 6/7/23. LPA conducted confidential interviews and reviewed documents during this investigation. During interviews with individuals invovled it was determined that the facility at times was operating out of ratio due to a staff shortage. There were times where there was only one staff member watching six clients. This lead to some of the individuals' needs not being met.Things individuals could do were limited due to not having enough staff to provide supervision for everyone. Based on interviews and documents review, the preponderance of evidence standard has been met, therefore the above listed allegations are found to be SUBSTANTIATED. As a result of this visit, there is one General Licensing Standards Personnel Requirements violation (80065(a)) an one General Licensing Standards Plan of Operation (80022(k)).The facility will be cited. Appeal rights were discussed and provided to ED. Exit interview was conducted and a copy of this report was provided to Daniel Padron Garcia, SS whose signature on this form confirm receipt of these documents (POC will be made on a different day due to Admin being ill). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: 435390042

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

Deficiencies:
80065: Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

report_type: Complaint Investigation

complaint_status: SUBSTANTIATED

title: Personnel Requirements (a)


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Investigation Findings:
13On 10/27/2023 at 9: AM, Licensing Program Analyst's (LPA) Shikya Belfield and LPA Celest Aparicio, conducted an unannounced complaint inspection to the above facility. The purpose of this inspection is to deliver the findings for the above allegations. LPA's met with administrator Princess Garcia who assisted with the inspection. Based on LPA's observations, conducted confidential interviews, and supportive documentation to include but not limit, incident reports. There were more than 10 incident reports and a minimum of five that were law enforcement contact, that were not reported to the department. It was also determined that during the evening hours of operation there is not facility manager on site while clients are in care. Facility is cited for violation of the California Code of Regulations, Title 22, Division Six, Section 84061(i) Reporting Requirements and 84065.2(a)(1)(A)(3) Personnel Duties as outlined on the following D. An exit interview was conducted a copy of this report along with appeal rights will be sent to Administrator Princess Garcia. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: 435390042

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90

met_with: Princess Garcia


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
These allegations are Substantiated. Facility cited for violation of the California Code of Regulations, Title 22, Division Six, Section, 84072(d)(10) Personal Rights, 84061(i) Reporting Requirements, and 84072.1(c) Discipline Policies and Procedures, as described on the following page 9099D. Section is 84061(i) is a repeat violation within twelve months and a civil penalty is being assessed. Advisory issued Welfare & Institutions Code Section 16001.9 (a)(1) Personal Rights. Advisory Issued. An exit interview was conducted and a copy of this report along with appeal rights, will be sent to House Manager Alyssa Avila, Administrator Amir Rafiei, and Maira Sanchez.

Investigation Findings:
13On 2/15/2024 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Celest Aparicio, conducted an unannounced inspection to the above facility. The purpose of this visit was to inform the facility representative of the findings for the allegations above. House Manager Alyssa Avila assisted with the inspection. Based on confidential interviews conducted, it was confirmed that staff spoke rudely to clients in care and made them feel uncomfortable. Based on observations by LPA's and review of supporting information including but not limited to, Incident Reports and video surveillance, clients were placed on psychiatrics holds prematurely. Based on observations of video surveillance and confidential interviews, incidents occurred at the facility and they were not reported to the department. Based on confidential interviews conducted, clients felt unsafe in their living environment where they were surrounded by all males and they were the only female. When expressed to staff, client was ignored, spoken to rudely, and no changes were made. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: VISIT DATE: 02/15/2024

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

met_with: Alyssa Avila


raw_content:
Investigation Findings:
13On 3/19/2024 at 12: PM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Mona Lam, conducted an unannounced inspection to the above facility. The purpose of this visit was to inform the facility representative of the findings for the allegations above. LPA met with Alyssa Avila who assisted with the inspection. Based on observations of video surveillance, confidential interviews, and supportive documentation to include but not limit incident reports. Incidents occurred at the facility and they were not reported to the department. Based on confidential interviews conducted and a review of supportive documentation to include but not limit, incident reports and video surveillance. The facility staff are not trained to for the program design / description of the program. Based on confidential interviews conducted and a review of supportive documentation to include but not limit, incident reports and video surveillance. Clients were affected by sexual incidents taking place in the facility and one client was not able to sleep in their room. Therefore, these allegations are Substantiated. Facility cited for violation of the California Code of Regulations, Title 22, Division Six, Section, 84072(d)(11) Personal Rights and 84061(i) Reporting Requirements. Section is 84061(i) is a second repeat violation within twelve months and a civil penalty is being assessed. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: 435390042

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


raw_content:
Investigation Findings:
13On 3/19/2024 at 12: PM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Mona Lam, conducted an unannounced inspection to the above facility. The purpose of this visit was to inform the facility representative of the findings for the allegations above. LPA met with Alyssa Avila who assisted with the inspection. Based on confidential interviews conducted and observations of video surveillance, and supportive documentation to include but not limit, incident reports. Staff were instructed not to contact emergency services and during one incident the client's lips turned blue and they were rushed to the hospital. Staff were also not trained on the medical emergency response. Therefore, this allegation is Substantiated. Facility cited for violation of the California Code of Regulations, Title 22, Division Six, Section 80075(a) Health Related Services as described on the following page LIC D. An exit interview was conducted and a copy of this report along with appeal rights were left with Alyssa Avila. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: 435390042

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


raw_content:
Narrative:
The preponderance of the evidence has been met. Therefore, these allegations are Substantiated. Facility is issued a Technical Violation Advisory for California Code of Regulations, Title 22, Division Six, Section 84070(b)(16) Childrens Records. Facility is cited for California Code of Regulations, Title 22, Division Six, Section 80022(k) Plan of Operation, 80070(a) Client Records, 84061(i) Reporting Requirements. An exit interview was conducted and a copy of this report along with appeal rights was left with Executive Director Amy Bravo.

Investigation Findings:
13On 8/27/2024 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Kristin Pierotti, conducted an unannounced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the findings for the complaint investigation regarding the allegations above. Executive Director Amy Bravo assisted with the inspection. Based on confidential interviews, obtained documentation to include but no limit, staff communication, medication records, and staff schedules. There were at least four occasions where staff were operating out of ratio according to the plan of operation. Based on confidential interviews, there was at least one occasion where parents were trying to contact their child and there was no answer and there was no answer by staff when contacting the facility. Due to this an appointment was missed. Based on a review a of medication administration records, the medication logs were missing information or incomplete and medication logs did not list reasons for missed medication. Based on a review of client files it was observed that client documents were incomplete. Based on observations of law enforcement call logs, staff communication, and incident report, there were incidents involving law enforcement that were not reported to the department. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: VISIT DATE: 08/27/2024

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90

met_with: Amy Bravo


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Investigation Findings:
13On 8/27/2024 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Kristin Pierotti, conducted an unannounced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the findings for the complaint investigation regarding the allegations above. Executive Director Amy Bravo assisted with the inspection. Based on confidential interviews, Although the above violation may have happened or is valid, there is not enough of the evidence to prove that the above allegations occured. The preponderance of the evidence has not been met and these allegations are Unsubstantiated. An exit interview was conducted and a copy of this report was left with Amy Bravo. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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: 90

complaint_status: unsubstantiated


raw_content:
Narrative:
Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 80022(k) Plan of Operation, 84064(c) Administrator qualifications and duties, and 80065(f) Personnel requirements as described on the following page LIC9099D. An exit interview was conducted a copy of this report was left with Executive Director Amy Bravo.

Investigation Findings:
13On 8/27/2024 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Kristin Pierotti, conducted an unannounced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the findings for the complaint investigation regarding the allegations above. Executive Director Amy Bravo assisted with the inspection. Based on confidential interviews, obtained documentation to include but no limit, staff communication, a review of prgram statement, staff training records, and staff schedules. It was observed that staff do not receive sufficient training hours or topics to perform their roles in the facility. Based on confidential interviews, it was confirmed that the administrator is not present in the facility and has not been for at least 60 days. Based on a review of facility program statement and plan of operation, facility has failed to follow the current plan of operation regarding, changes to staff schedules, changes to administrative staff, and accepting clients outside of the listed reuirements in the plan of operation. Based on observations of staff schedules and plan of operation, it was confirmed that facility staffing was not in ratio on at least four occassions. Therefore these allegations are Substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: VISIT DATE: 08/27/2024

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On September 8, 2025 at 10: AM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the finding for the above allegation. Christine Ziemba assisted LPA with the inspection. Based on confidential interviews, statements indicated that staff responded accordingly to youth's actions when entering the pantry,which was a restricted area. LPA did not observe yelling from staff at the time of the inspection. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Christine Ziemba prior to exiting the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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: Christine Ziemba, Clinical Director


raw_content:
Narrative:
Based on confidential interviews, statements indicated that there was moldy bread on the premises occasionally. However, statements indicated that moldy bread was thrown away accordingly in addition to the chef checking the refrigerator frequently. LPA conducted physical plant checks and did not find moldy food being served to clients. Interviews indicated that one youth exhibited sexual behaviors and made sexual innuendos towards other clients. Interviews also indicated that staff intervene when behaviors are exhibited in addition to having multiple conversations with youth, including by the director. Redirection was provided accordingly when witnessed. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies were cited at this time. A copy of this report was given to Micki Hankes prior to exiting the facility.

Investigation Findings:
13On September 30, 2025 at 3: PM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the finding for the above allegations. Micki Hankes assisted LPA with the inspection. Based on the report, the complaint was about staff violating clients' personal rights. This includes staff allegedly not allowing clients to call licensing and allegedly staff threatening to send clients to a locked facility. Interviews indicated that staff do not deny calls to clients. In addition, youth were able to call licensing to make a complaint while being at the facility. Interviews had discrepancies regarding whether incidents of threatening youth to be sent to locked facilities had occurred or not. This is due to some clients and staff admit conversations did occur, however some staff discuss potential higher levels of care for youth based on their behaviors. LPA issued a technical advisory regarding language used to discuss higher levels of care towards clients. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: VISIT DATE: 09/30/2025

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

met_with: Micki Hankes


raw_content:
Investigation Findings:
13On September 30, 2025 at 3: PM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the finding for the above allegation. Micki Hankes assisted LPA with the inspection. Based on confidential interviews, multiple staff reported they have not seen clients treated disrespectfully or talk about clients in a degrading/demeaning manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies were cited at this time. A copy of this report was given to Micki Hankes prior to exiting the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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:


raw_content:
Investigation Findings:
13On September 30, 2025 at 3: PM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the finding for the above allegation. Micki Hankes assisted LPA with the inspection. Based on confidential interviews and residential shift notes, it was confirmed that a client exhibited sexual behaviors and made sexual innuendos towards other clients. Interviews and residential shift note also indicated that staff intervene when behaviors are exhibited in addition to having multiple conversations with youth, including by the director. Redirection was provided accordingly when witnessed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies were cited at this time. A copy of this report was given to Micki Hankes prior to exiting the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 2

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


raw_content:
Investigation Findings:
13On 10/13/2025 at 1: PM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection at the above facility. The purpose of this inspection is to inform the facility representative of the findings for the complaint investigation regarding the allegation above. This LPA met with Facility Manager, Ms. Young, who assisted with the inspection. Based on confidential interviews, and documents reviewed, it was determined there was a lack of supervision which caused two clients in care to bathe together while staff were not providing supervision. Therefore this allegation is Substantiated. As such, the facility was cited for a violation of California Code of Regulations, Title 22, Division Six, Section 80078(a) Responsibility for Providing Care and Supervision as described on the following page LIC 9099-D. An exit interview was conducted at 3: PM, and a copy of this report was left with Ms. Young. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: 435390042

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

met_with: Mary Young


raw_content:
Investigation Findings:
13On 10/13/2025 at 1: PM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection at the above facility. The purpose of this inspection was to inform the facility representative of the findings for the complaint investigation regarding the allegation above. This LPA met with Facility Manager, Ms. Young, who assisted with the inspection. Based on confidential interviews, prior citations for the same allegation, and the fact that staff are transporting clients to their other facility locations indicates that the facility staff is out of ratio. However, the staff are making attempts to ensure by providing an alternative option to comply with the regulation for staffing. Hence, this LPA could not determine a specific date and time the facility staff were out of ratio. As such, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is Unsubstantiated. An exit interview was conducted at 3: PM, and copy of this report was provided to Ms. Young. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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:


summary: Facility Evaluation

raw_content:
Narrative:
On 3/22/23 at 10: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility Main Office which is located at the Middle Ave. Facility. The purpose of this visit was to conduct the required Post Licensing Inspection. LPA met with Brandy Spindel (CD), Clinical Director, to conduct the required annual inspection. LPA reviewed one staff files and five client flies. No deficiencies were cited at this time. LPA conducted an exit interview with Brandy Spindel, CD at 3: PM.

met_with: Brandy Spindel, Clinical Director


summary: Facility Evaluation

raw_content:
Narrative:
On 3/22/23 at 9: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required Post Licensing Inspection. LPA met with Chris Van Nu Land (RD), Residential Director, to conduct the required annual inspection. LPA conducted plaint, operations, disaster preparedness, emergency intervention, staff, clients sections, interviewed three staff members, and three clients. The Annual Inspection is complete at this time. Technical Violations, and Technical assistance were cited at this time. LPA conducted an exit interview with Chris Van Nu Land, RD.

met_with: Chris Van Nu Land, Residential Director


summary: Facility Evaluation

raw_content:
Narrative:
On 6/30/23 at 11:35 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA Tiffany Carey, Interm Clinical Director (ICM) met with at the above facility to conduct the required annual inspection. LPA completed Plant inspection and interviewed three staff and three clients. At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Tiffany Carey, ICM and a copy of the report sent to the facility.

met_with: Tiffany Carey, Interm Clinical Director


summary: Facility Evaluation

raw_content:
Narrative:
On 7/6/23 at 11:00 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA Tiffany Carey, Interm Clinical Director (ICM) met with at the above facility to conduct the required annual inspection. LPA completed Operations, Emergency Interventions, and Disaster Preparedness sections. At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Tiffany Carey, ICM and a copy of the report sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/19/23 at 12: PM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA Tiffany Carey, Interm Clinical Director (ICM) met with at the above facility to conduct the required annual inspection. LPA completed Staff and Client sections. LPA reviewed three client and five staff files. The inspection is complete, seven Technical Violations and three Technical Assistance were cited at this time. LPA conducted an exit interview with Tiffany Carey, ICM and a copy of the report sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield and LPA Celest Aparicio, conducted an unannounced inspection at the above facility. The purpose of this inspection is to conduct case management regarding information received by the department on the facilities operations. Based on a review of the guardian system the facility has more than two staff who are not associated to the facility. LPA discussed the staff associations with administrator Princess Garcia who assisted with the inspection. LPA requested the following documents from administrator Garcia; training records for all staff, needs and services plan for all clients and a copy of the grocery order that was placed for the facility. During a walk-through of the facility with administrator Garcia, LPA's observed the facility to not have enough snacks and food items available for the clients in care to obtain regularly without assistance. LPA's also observed during this inspection were missing forms on the facility walls such as personal rights and activity schedule. Also observed were locked food cabinets. LPA's discussed these issues with administrator Garcia. Due to time restrictions and technical issues with LPA equipment, this inspection must be completed at a later date. At that time all issues and citations will be addressed. LPA's left the facility with facility documents ( incident report binder) that will be returned to the facility within the required time frame. An exit interview was conducted a copy of this report will be sent to administrator Princess Garcia.


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2024, at 10:00am, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted a required annual inspection at Embark at San Martin - New Avenue Campus. The facility is a Group Home, for a capacity of 6 ambulatory children, ages 12-17. This inspection was conducted with , Executive Director, Amy Bravo, of the following: The facility is a one story home. The home includes three client bedrooms; three and a half client bathrooms; kitchen and living room; area set up for school; mindfulness nook; a private space to meet with clients; a staff office; an admissions office; and, an isolation room/extra office, with a Murphy bed, which will only be used for COVID positive clients or additional staff space. The facility and grounds are in good repair, and free of obstructions; chemicals are stored and locked in the closet; locked and centrally stored medication room/cabinet observed; observed medication logs and discussed procedures for psychotropic medications; first aid kit complete; individual beds are in good repair; food storage space observed; emergency foods observed; perishable foods and nonperishable foods will be bought as soon as licensed and have a placement; dining room equipped with tables and chairs accommodating all clients; all smoke detectors were tested by a fire inspector and appear to be in proper working order; carbon monoxide detector observed; fire extinguishers are properly charged; appropriate forms are posted in view of facility clients; and, no firearms or weapons are allowed in the facility or on premises. The backyard includes a swimming pool/hot tub with fencing (facility meets the regulation requirements for inaccessibility for their population); outdoor BBQ area; solar paneling in the far rear of the property; garden area; dog kennel (which is not utilized unless for storage); and, grapevines on the extended property. All staff and client files are electronic, and hard copies are available to Community Care Licensing (CCL) for review. On today's date, there were not any deficiencies cited LPA conducted an exit interview with Ms. Bravo, at 4: PM. A copy of this document was emailed to Amy Bravo..

met_with: Catherine Squires


summary: Facility Evaluation

raw_content:
Narrative:
An informal meeting is being held on April 2, 2025, at 10: AM. The reasons for the meeting are for prior concerns in 2024, at the aforementioned facility. In addition, components two and three will be completed for the new facility currently under application review, pending a provisional license, with Licensing Program Analyst (LPA) Mona Lam. Present in the meeting: Licensing Program Manager, (LPM) Joel Segura, Licensing Program Analysts (LPA) Vaishali Singh-Sood, and Mona Lam, Administrator, Amir Rafiei, and Executive Director, Micki Hankes . Between the dates of November 2023 through April 2024, the following citations were given to the aforementioned facility: client medication are not properly documented, clients were not given medications as prescribed, facility is operating out of ratio, clients are not able to receive phone calls, client files are incomplete, facility failed to report incidents to the department (multiple times), staff working without having Criminal Record clearance, staff did not seek medical attention to minor in a timely manner, staff are not qualified, facility failed to provide an environment free from emotional abuse, Clients are not accorded dignity in their relationship with staff, clients are unjustifiably placed on a psychiatric hold, Clients do not feel safe, healthy, or comfortable in the facility and clients do not feel they are treated with respect. The following deficiencies and concerns were discussed with Mr. Rafiei and Ms. Hankes. It was also indicated that additional inspections at the facility may occur at the discretion of Community Care Licensing (CCL) to ensure compliance, as well as the safety of clients in care are being met. It is noted there have not been any deficiencies at the facility since April 2024. During the meeting Ms. Hankes, and Mr. Rafiei informed the department that the facility has made several changes to improve how the facility operates. A few examples shared were new staff on floor first while shadowing, supervisor has a new hire check list, more than the minimum ratio 1:6 more daily staff, upgraded program narrative, client files periodically updated, and going to an electronic version, an increase of administrative staff, more competitive raised salary to retain employees, on going training provided weekly, a therapist on site attending a Master's program, and a change in culture, with an improvement in the overall program including continuous improvement in strategies. The meeting was concluded at 12: PM, and a copy of this report was provided via email to Ms. Hankes. Due to the meeting being conducted via Microsoft Teams, the original signatures will be kept in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2025, at 10:45am, Licensing Program Analyst (LPA) Mona Lam conducted a required annual inspection at Embark at San Martin - New Avenue Campus. The facility is a Group Home, for a capacity of 6 ambulatory children, ages 12-17. This inspection was conducted with Executive Director, Micki Hankes, of the following: The facility is a one story home. The home includes three client bedrooms; three and a half client bathrooms; kitchen and living room; area set up for school; a private space to meet with clients; and a staff office. LPA Lam observed rugs in each of the bathrooms that are able to slip. LPA Lam issued a technical violation under 80087(b)(1) Buildings and Grounds. The facility and grounds are in good repair, and free of obstructions; chemicals are stored and locked in the closet; locked and centrally stored medication room/cabinet observed; first aid kit complete; individual beds are in good repair; food storage space observed; emergency foods observed; perishable foods and nonperishable foods were observed; dining room equipped with tables and chairs accommodating all clients. LPA Lam observed a flour bag and marshmallow bag opened in pantry. In addition, LPA Lam observed some items in the pantry freezer that are not dated. LPA Lam advised in labelling dates consistently in addition to properly sealing food items to prevent contamination under 80076(a)(18) Food Service. (Continued on LIC 809-C). Freezer temperature was observed as -5 degrees F; refrigerator temperature was observed as 35 degrees F. Room temperature was observed as 71 degrees F. Tap water temperature was observed as 127.4 degrees F. LPA did not observe warning signs for the high water temperature. LPA Lam issued a Type A deficiency under 8088(e)(2) Fixtures, Furniture, and Supplies (see LIC 809-D). The following documents were inspected: registrar of clients, bedroom compatibility assessment, board of directors' meetings minutes, clients' complaint procedures, disaster/mass casualty plan, photos of valve shut offs, fire clearance, past licensing reports, quarterly emergency disaster drills, and other information being readily available within an emergency. LPA Lam did not observe procedures of storage and preservation of medications that require refrigeration, although information of storage and preservation of medication is provided. LPA Lam issued a technical advisory under 1565(a)(7)(E) Other Provisions. Facility is trained in holds, although facility does not actively use hold techniques. LPA Lam did not observe a monthly log of each use of manual restraints. LPA Lam issued a technical violation under 84361(f) Documentation and Reporting Requirements. LPA Lam inspected a portion of the client files, but has not finished. At this time the inspection, it is not complete and it will be concluded at a later date. One (1) deficiency was cited and two (2) technical violations and two (2) technical advisories were issued at the inspection. An exit interview was conducted a copy of this report and appeals rights page were discussed, printed, and delivered to Micki Hankes prior to leaving the facility.

met_with: Micki Hankes, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 1, 2025, 12: PM Licensing Program Analyst (LPA) Mona Lam conducted a continuation required annual inspection at Embark at San Martin - New Avenue Campus. The facility is a Group Home, for a capacity of 6 ambulatory children, ages 12-17. This inspection was conducted with Christine Ziemba, Clinical Director, of the following: LPA Lam inspected client medication. One medication for a client was found in a Ziploc bag. LPA asked nurse if medication has been distributed to youth. Nurse stated that medication provided was by parent during intake. Nurse stated that they needed to destroy medication, but had ordered youth the replacement medication. LPA conducted two staff interviews and two client interviews. LPA inspected client files and found multiple clients' treatment plans did not contain clients' signatures. LPA issued a Type B deficiency under 84070(c)(1) Children's Records. LPA inspected staff files. LPA was unable to observe multiple staff members' competency tests regarding emergency intervention. LPA issued a technical violation under 84365(d)(1)(C) Emergency Intervention Plan. At this time the inspection, it is not complete and it will be concluded at a later date. One (1) deficiency was cited and one (1) technical violation was issued at the inspection. An exit interview was conducted a copy of this report and appeals rights page were discussed, printed, and delivered to Christine Ziemba, Clinical Director prior to leaving the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On July 8, 2025, 1: PM Licensing Program Analyst (LPA) Mona Lam conducted a continuation required annual inspection at Embark at San Martin - New Avenue Campus. The facility is a Group Home, for a capacity of 6 ambulatory children, ages 12-17. This inspection was conducted with Micki Hankes, Administrator, of the following: LPA Lam inspected staff files. During the inspection, LPA was unable to review the following documentation: training on responsibilities during an emergency or disaster (one out of five staff files), and facility manager training (one out of one staff file). LPA issued a technical assistance under 1565(b) Other Provisions. LPA issued a technical violation under 84065(d)(3) Personnel Requirements. Administrator stated the assessment within 7 calendar days of completion of 8 hour training is completed during the job shadowing, hence it is not documented. LPA Lam advised in separating activities to indicate an assessment was conducted. LPA issued a technical assistance under 84065(i)(1)(D)(2) Personnel Requirements. One (1) technical violation and two (2) technical assistances were issued at the time of the inspection. An exit interview was conducted and a copy of this report was discussed, printed, and delivered to Micki Hankes, Administrator prior to leaving the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On October 30, 2025 at 10: PM, Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to follow up on an incident report received on October 28, 2025. At the time of the visit, there were five clients at the facility. LPA issued a technical advisory regarding reporting requirements under 84061(i) Reporting Requirements. In addition, a technical advisory was issued under 80061(b)(2) Reporting Requirements. No deficiencies were cited at this time. A copy of this report was given to Micki Hankes prior to exiting the facility.


raw_content:
Narrative:
The preponderance of the evidence standard has been met; therefore, the allegation is SUBSTANTIATED. A copy of this report and appeals rights were given to Micki Hankes prior to exiting the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies were cited at this time. A copy of this report and appeals rights were given to Micki Hankes prior to exiting the facility.

Investigation Findings:
13On October 30, 2025 at 12: PM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the findings for the above allegation. Micki Hankes assisted LPA with the inspection. Based on the program statement, it stated the emergency room (ER) of choice was in Gilroy. Based on confidential interviews and incident reports, youth were transported to a different location other than the mentioned ER. This poses a potential Health, Safety, and/or Personal Rights risk to clients in care. LPA issued a Type B deficiency under 80020(k) Plan of Operation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: VISIT DATE: 10/30/2025

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


raw_content:
Narrative:
Based on the program statement, it states release of client related data/information is specifically prohibited without the express, written consent/permission of the client and client's parent/legal guardian. Based on the program statement, it states that client's records are open to inspection by client's authorized representative. Although the facility is following based on their release of information protocol, the facility is prohibiting client's authorized representative from inspection of client's records. LPA issued a technical violation under 80070(e) Client Records. The preponderance of the evidence standard has been met; therefore, the allegation is SUBSTANTIATED. No deficiencies were cited at this time. A copy of this report and appeals rights were given to Luis Martinez prior to exiting the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies were cited at this time. A copy of this report and appeals rights were given to Luis Martinez prior to exiting the facility.

Investigation Findings:
13On November 5, 2025 at 11: AM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the findings for the above allegation. Luis Martinez assisted LPA with the inspection. Based on an email chain between minor's parent and the facility, it indicated parent made multiple requests to obtain client records. Email chain indicated administrator sending parent a form of medical records release prior to the request to be fulfilled. Form indicates authorization to agencies/programs on the use or disclosure of protected health information. Email chain indicated minor's parent had not sent facility a filled-out form. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN-NEW AVENUE CAMPUSFACILITY NUMBER: VISIT DATE: 11/05/2025

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

met_with: Luis Martinez, Assistant Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On December 3, 2025 at 10: AM, Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to amend a report and re-cite a deficiency. LPA did not receive an incident report of the incident. This poses potential Health, Safety, and/or Personal Rights risk to clients in care. LPA issued a Type B deficiency under 80061(b)(1)(E) Reporting Requirements. A copy of this report and an appeals rights page were given to Micki Hankes prior to exiting the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield and LPA Celest Aparicio, conducted an unannounced inspection at the above facility. The purpose of this inspection is to complete the case management inspection conducted on 10/24/2023. LPA's met with Brittany Haug who informed these LPA's that administrator Garcia would be arriving in one hour. LPA Belfield returned incident report binder to Staff Haug that was taken from facility during the previous inspection. Based on LPA observations, conducted confidential interviews, and supportive documents to include but not limit, incident reports and staff schedules. It was confirmed that during the day, clients do not have regular access to snacks between meals as required by the regulations. It was observed by LPA's that cabinets containing snacks are locked. During the inspection on 10/24/2023, LPA Belfield requested the needs and service plans for all clients in care, although three clients plans were submitted, seven were not. As of today's date, LPA has not been given the plans for the clients. During the inspection on 10/24/2023, LPA's observed the pool in the back of the facility does not have a secured fence surround the pool, that is required to be inaccessible to clients in care. It was confirmed that the facility performs restraints on the clients in care which is not a part of the program design. Based on observations of provided staff schedules and a review of the guardian system, the facility has Seven staff (see LIC 811 dated 10/27/23) who are not criminally record cleared to work in the facility and seven staff who are not associated to the facility. Facility is being cited for violation of the California Code of Regulations. Title 22. Division, Six, Section 80019(e)(2) Criminal Record Clearance. Facility is being assessed a civil penalty. Facility is being cited for the following violations of the California Code of Regulations, Title 22, Division Six, Sections 80022(k) Plan of Operation, 84044(b) Inspection Authority, 80087(e) Buildings and Grounds, and 80076(a)(4) Food Services as described on the following page D. LPA Belfield and Administrator Princess Garcia discussed the concerns of the facilities operations and an informal meeting will be scheduled with administrator and program vice president. An exit interview was conducted and a copy of this report along with appeal rights will be sent to administrator Princess Garcia.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/15/2024 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Celest Aparicio, conducted an unannounced inspection to the above facility. The purpose of this inspection is to conduct a case management regarding information received by the department. On 10/27/2023 during an inspection, the facility was cited for having staff working without having Criminal Record clearance. Based on confidential interviews conducted on 2/6/2024, it was confirmed that S4 and S7 (see LIC811 dated 10/27/23) continued working at Embark with youth since 10/27/2023. Facility is being cited for violation of the California Code of Regulations. Title 22. Division, Six, Section 80019(e)(2) Criminal Record Clearance. Facility is being assessed a civil penalty for failing to correct the violation. An exit interview was conducted and a copy of this report was sent to House manager Alyssa Avila, Amir Rafiei, and Maira Sanchez.


facility_name: EMBARK AT SAN MARTIN - SAN MARTIN AVE

raw_content:
Investigation Findings:
13On September 30, 2025 at 10: AM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the findings for the above allegation. Micki Hankes, Administrator assisted LPA with the inspection. Based on confidential interviews, it was confirmed that staff spoke sarcastically to clients in care regarding their treatment progress in front of multiple clients. Multiple statements were made regarding a staff's conversation towards a youth was deemed sarcastic in addition to statements aligned in the delivery of the tone and words used in the conversation. This is a potential Health, Safety, and/or Personal Rights risk to clients in care. LPA issued a Type B deficiency under 84072(d)(18) Personal Rights. The preponderance of the evidence standard has been met; therefore, the allegation is SUBSTANTIATED. A copy of this report and appeals rights were given to Micki Hankes, Administrator prior to exiting the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN - SAN MARTIN AVEFACILITY NUMBER: 435390063

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


raw_content:
Narrative:
The preponderance of the evidence standard has been met; therefore, the allegation is SUBSTANTIATED. A copy of this report and appeals rights were given to Micki Hankes prior to exiting the facility.

Investigation Findings:
13On September 30, 2025 at 10: AM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the findings for the above allegation. Christine Ziemba assisted LPA with the inspection. Based on confidential interviews, it was stated that clients were moved to another facility temporarily due property damaged caused by a youth on 09/09/25. Multiple interviews stated upon clients' return to the property, there was some remaining glass on the exterior. Multiple interviews and an incident report on 09/16/25 confirmed one client was injured due to removing glass from broken windows. Based on LPA's observations on 09/18/25 and 09/30/25, multiple windows on the property were broken on the exterior panels. This was observed on the day that clients were on the property. This poses an immediate Health, Safety, and/or Personal Rights risk to clients in care. LPA issued a Type A deficiency under 80087(a) Buildings and Grounds. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN - SAN MARTIN AVEFACILITY NUMBER: 435390063

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


raw_content:
Narrative:
LPA reviewed files and found that the department did not receive an incident report of the incident. This poses potential Health, Safety, and/or Personal Rights risk to clients in care. LPA issued a Type B deficiency under 80061(E) Reporting Requirements. The preponderance of the evidence standard has been met; therefore, the allegation is SUBSTANTIATED. A copy of this report and appeals rights were given to Micki Hankes prior to exiting the facility.

Investigation Findings:
13On October 17, 2025 at 10: AM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the findings for the above allegation. Micki Hankes assisted LPA with the inspection. The alleged incident that occurred is that youth met a staff member's partner during an outing, which resulted in the partner throwing gang signs at the youth. Based on staff training, it was indicated that under no circumstances are the driver and the use of personal vehicles permitted to transport clients whether on shift or not on shift. Based on interviews, there is a discrepancy if an altercation occurred, however, it was confirmed during an outing with a client, a staff member met up with their partner with the client present. This poses immediate Health, Safety, and/or Personal Rights risk to clients in care. LPA issued a Type A deficiency under 84072(d)(19) Personal Rights. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN - SAN MARTIN AVEFACILITY NUMBER: VISIT DATE: 10/17/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
On December 20, 2024, at 10: AM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted a pre-licensing inspection. Embark at San Martin - San Martin Ave has submitted an application for a Group Home license, for a capacity of 6 ambulatory children, ages 12-17. This inspection was conducted with Amy Bravo and included observation of the following: The facility is a two story home. The home includes 3 client bedrooms; 2 client bathrooms; kitchen and parlor room; dining room, butler's pantry area set up for school; mindfulness nook; two private spaces to meet with clients; a staff office; an admissions office; and, an isolation room/extra office, with a Murphy bed, which will only be used for COVID positive clients or additional staff space. The facility and grounds are in good repair, and free of obstructions; chemicals are stored and locked in the closet; locked and centrally stored medication room/cabinet observed; observed medication logs and discussed procedures for psychotropic medications; first aid kit complete; individual beds are in good repair; food storage space observed; emergency foods observed; perishable foods and nonperishable foods will be bought as soon as licensed and have a placement; dining room equipped with tables and chairs accommodating all clients; all smoke detectors were tested by a fire inspector and appear to be in proper working order; carbon monoxide detector observed; fire extinguishers are properly charged; appropriate forms are posted in view of facility clients; and, no firearms or weapons are allowed in the facility or on premises. The backyard includes three patio areas, and two separate lawns; two seating areas, fireplace area, an outdoor BBQ area; and a garden area. All staff and client files are electronic and available to Community Care Licensing (CCL). Embark at San Martin - San Martin Ave will ready for licensing upon completion of the approved Program Statement which is currently in review.


summary: Facility Evaluation

raw_content:
Narrative:
On August 27, 2025 at 11: AM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is inspect the physical plant. At the time of the inspection, there were two clients in care. LPA met with Micki Hankes, Administrator. LPA inspected refrigerator and observed perishables within refrigerator. LPA advised for facility to maintaining fresh perishable foods for a minimum of two days on the premises. LPA observed a posted menu of the previous week and not an updated menu of the current week. LPA issued a technical violation under 84076(b) Food Service. LPA observed telephone to be located in a public area near the entrance. LPA advised phone to be located in an area for youth to conduct confidential calls. LPA asked administrator where grievance forms can be submitted to the facility. Administrator indicated it is next to the locked box for youth to submit near to the entrance of the facility. LPA did not observe any indication of the purpose of the locked box. LPA advised posting a sign next to the locked box for complaint purposes. LPA inspected exterior of the property. LPA observed grill with an open drawer of a connected gas tank. LPA advised administrator to close drawer to prevent youth from accessing potential hazardous items. No deficiencies were cited at this time. An exit interview was conducted with Micki Hankes, Administrator and a copy of this report was printed and left with Micki Hankes, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, at 10: AM, Licensing Program Analysts (LPA) Mona Lam and Amee Li conducted a post-licensing inspection. At the time of the inspection, there are three clients at the facility and three staff members. Micki Hankes, Administrator, assisted LPAs with the inspection. The facility is a two story home. The home includes 3 client bedrooms, 2 client bathrooms, kitchen, dining room, a staff office, and nurse's office. Two of the client bedrooms have holes in the walls, including broken doors. However, the facility shows signs of repair. Facility provided rugs, but were slightly non-slip. LPAs advised in taping rugs down if non-slip were not provided and issued a technical assistance under 80087(b)(1) Buildings and Grounds. The facility is free of obstructions. The facility have enclosed fireplace areas. Rights were posted on board, however it showed one page of the rights and did not include all the rights. LPAs advised in ensuring all rights were visibly posted and issued a technical assistance under 84072(a) Personal Rights. Chemicals are stored and locked in the closet; hygiene products and clean linens were located, locked and centrally stored medication room/cabinet observed; observed medication logs; first aid kit complete; individual beds are in good repair; food storage space observed; emergency foods observed; perishable foods and nonperishable foods were identified. (Continued on LIC 809-C). Carbon monoxide detectors were located at different wall outlets. The backyard includes three patio areas, and two separate lawns; two seating areas, fireplace area, an outdoor BBQ area; and a garden area. LPAs inspected emergency disaster plan. Material of storage of medications, including refrigeration, were not identified in emergency disaster plan. LPAs issued a technical violation under Health and Safety Code 1565(a)(7)(E). Needs and services plan were not identified in emergency binder. LPAs issued a technical violation under Health and Safety Code 1565(e)(2). LPAs inspected manual restraint log. Description of the interventions prior to holds were written, however it does not contain description of the interventions used. LPAs issued a technical violation under 84361(f)(5) Documentation and Reporting Requirements. Dates were mentioned, however the time of day that the intervention was used was not identified. LPAs issued a technical assistance under 84361(f)(2) Documentation and Reporting Requirements. LPAs inspected three client records. Bedroom compatibility assessment was identified, however there was a lack of content regarding why youth were compatible with one another. LPAs issued a technical assistance under 84087(e) Building and Grounds. At this time, LPAs have not finished the post-licensing inspection and will return to finish reviewing client files, staff files, etc. No deficiencies were cited at this time. An exit interview was conducted with Micki Hankes, Administrator and a copy of this report was printed and left with Micki Hankes, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, at 10: AM, Licensing Program Analysts (LPA) Mona Lam and Amee Li conducted a continuation of the post-licensing inspection. At the time of the inspection, there are three clients at the facility and two staff members. Micki Hankes, Administrator, assisted LPAs with the inspection. LPAs conducted three client interviews and two staff interviews. LPAs inspected the remaining three client files. LPAs were not able to identify one of the three client's immunization records. LPAs inspected five staff files. The following items were missing from staff files: facility manager training, one staff file is missing on mandated reporting/incident reporting. LPAs issued technical violations under 84070(c)(3) Children Records, 84065(d)(3) Personnel Requirements, and 84065(i)(3)(C) Personnel Requirements. No deficiencies were cited at this time. An exit interview was conducted with Micki Hankes, Administrator and a copy of this report was printed and left with Micki Hankes, Administrator.


raw_content:
Investigation Findings:
13On November 5, 2025 at 10: AM Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to deliver the findings for the above allegation. Chad Oldenburg assisted LPA with the inspection. Based on confidential interviews, interviews stated there are incidents on C1 and C2 would cross boundaries or have fights, however none of the incidents indicated client would touch another client inappropriately. Based on residential shift notes, incident report, and interviews, there are multiple occasions staff would intervene between C1 and C2 if youth were crossing boundaries or fighting. Staff used verbal or physical interventions. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies were cited at this time. A copy of this report was given to Chad Oldenburg prior to leaving the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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: Chad Oldenburg, Assistant Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On February 3, 2026 at 10: AM, Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to follow up on multiple incident reports regarding a youth runaway in January 2026. At the time of the visit, there were four clients at the facility. LPA requested the following documentation: - Additional incident reports on the youth's runaway from multiple sites - 15 minute check in logs - Shift notes on youth's runaway At this time, further investigation is needed. An exit interview was conducted and a copy of this report was given to Micki Hankes, Administrator, Chad Oldenburg, Assistant Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
On February 3, at 11: AM, Licensing Program Analyst (LPA) Mona Lam conducted a required annual inspection. At the time of the inspection, there are four clients and three staff on site. Micki Hankes, Administrator, and Chad Oldenburg, Assistant Program Director assisted LPA with the inspection. The facility is a two story home. The home includes 3 client bedrooms, 2 client bathrooms, kitchen, dining room, a staff office, and nurse's office. The facility is in good repair. Facility provided rugs, but were slightly non-slip. The facility is free of obstructions. The facility have enclosed fireplace areas. Chemicals are stored and locked in the closet; hygiene products and clean linens were located, locked and centrally stored medication room/cabinet observed; observed medication logs; first aid kit complete; individual beds are in good repair; food storage space observed; emergency foods observed; perishable foods and nonperishable foods were identified. Carbon monoxide detectors were located at different wall outlets. The backyard includes three patio areas, and two separate lawns; two seating areas, fireplace area, an outdoor BBQ area; and a garden area. LPA inspected emergency disaster plan and manual restraint log, which were in compliance. LPA inspected four client records. Chris Van Nuland, Academic Coordinator, provided current client's education records, which is in compliance. Bedroom compatibility assessment was identified, however there was a lack of content regarding why youth were compatible with one another. During inspection of client's records, LPA found verbal consent documentation of each psychotropic medication. However, LPA was unable to locate written authorization for each consent. LPA issued a Type B Citation under 84070(b)(15) Children's Records. (Continued on LIC809-C) LPA inspected two staff files. At this time, the facility's training platform has been switched and is not working at it's full capacity (ex: displaying hours of training, prudent parent training, program policies/procedures, client's rights). Facility currently is re-doing their facility manager training, which is unavailable at this time. LPA will return at a later date to complete staff file review. One deficiency was cited at this time. An exit interview was conducted with Micki Hankes, Administrator and Chad Oldenburg, Assistant Program Director and a copy of this report was printed with appeals rights page and left with Micki Hankes, Administrator and Chad Oldenburg, Assistant Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
On February 10, 2026 at 11: AM, Licensing Program Analyst (LPA) Mona Lam followed up on multiple incident reports regarding a youth runaway in January 2026. At the time of the visit, there were four clients at the facility. LPA conducted one confidential interview. At this time, further investigation is needed. An exit interview was conducted and a copy of this report was given to Micki Hankes, Administrator, and Chad Oldenburg, Assistant Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
On April 3, 2026 at 12: PM, Licensing Program Analyst (LPA) Mona Lam made an unannounced inspection to the above listed facility. The purpose of this inspection is to follow up on multiple incident reports regarding a youth runaway in January 2026. At the time of the visit, there were four clients at the facility. LPAs reviewed incident reports to CCL, facility's incident reports, sheriff's call logs and incident reports, and conducted staff interviews. During the review of facility's incident reports, LPA identified multiple incidents that were not reported to the department. These incidents were additionally verified with sheriff's call logs and incident reports. LPA issued a Type B deficiency under 80061(b)(1)(E) Reporting Requirements. LPA conducted a physical plant inspection and found little mice feces in drawers. These drawers did not have any food or storage for food utensils. LPA followed up with facility regarding practices of pest control as well as ensuring mold/mildew is not developing/reoccurring. An exit interview was conducted and a copy of this report with the appeals rights page were given to Micki Hankes, Administrator and Chad Oldenburg, Assistant Program Director.


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
In addition, LPAs observed that cabinets underneath the kitchen sinks require deep cleaning, as they were observed to have a buildup of humidity, resulting in mold and water stains on the corresponding walls of the cabinets. LPAs observed liquid spills in the garage refrigerator. The garage refrigerator was partially taped up at the bottom drawers. LPA Lam was able to use their state issued iphone to capture photos of the items listed above. Based on observation and photographic evidence obtained, the "preponderance of the evidence" standard has been met. Therefore, the above allegations are substantiated. A Type A deficiency was issued for the cabinets underneath the kitchen sinks and the garage refrigerator not being in good repair. This was cited under California Code of Regulations (CCR) 80087(a) Buildings and Grounds. Another Type A deficiency was issued to the licensee for excrement of mice in the storage areas and near the food preparation area. This was cited under CCR 80076(a)(17) Food Services. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Shanice Reeds prior to exiting the facility. LPAs issued an advisory note for the facility regarding items in the freezer that are iced up. No deficiency was cited at this time. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Shanice Reeds prior to exiting the facility.

Investigation Findings:
13On March 16, 2026 at 12: PM, Licensing Program Analysts (LPAs) Mona Lam and Amee Li made an unannounced inspection to the above listed facility. The purpose of this inspection is to open a complaint. LPAs discussed with Shanice Reeds, Assistant Program Director who assisted with the inspection. LPAs conducted a physical plant inspection. LPAs inspected the kitchen cabinets, drawers, main refrigerator, and the garage's refrigerator (extra food storage for clients). Based on physical evidence observed on 03/16/26, it was determined that the facility is in disrepair and in need of deep cleaning. On today's date, LPAs observed the facility's bottom cabinets in the kitchen area have excrement of mice. These cabinets contain baking supplies and art supplies. LPAs observed additional mice excrement in the drawers by the sink, in the back of the shelves in the food pantry, and on the floor of the pantry. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: EMBARK AT SAN MARTIN - SAN MARTIN AVEFACILITY NUMBER: VISIT DATE: 03/16/2026

met_with: Shanice Reed, Assistant Program Director


facility_name: EMMANUEL FAMILY HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2022 at 9:30am, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced annual inspection of the Emmanuel Family Home and met with Facility Administrator Jonathan Sparhawk. The home is a one story residence with 5 bedrooms and 2 bathrooms. The facility currently serves six clients. LPA inspected the facility interior and exterior. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The living room consists of a television with a spacious living room and three couches. The facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The facility maintains at least one week supply of nonperishable, snacks, and a 2 day supply of perishable foods. Bedrooms are furnished and have adequate shelf and closet space for client's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed clean bath towels, and washcloths available for clients. The bathrooms were clean and in good repair. The facility has air conditioner throughout the house and maintained at a comfortable temperature. Hot water temperature measures 116.0 degrees. There are no weapons or firearms at facility. Medications and First Aid kit are locked and centrally stored dining room/ office cabinet. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. All hazardous items have been properly made inaccessible to areas where clients will have access. Cleansers/chemicals are locked and stored under the sink. Sharp knives are inaccessible and stored in a locked cabinet in the dining/ staff area. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, and current menu. (see continuation form LIC-809C dated 01/21/22) LPA reviewed Physical Plant, Operations, Disaster Preparedness, and Emergency Intervention. LPA conducted staff and client file reviews and interviews. LPA conducted 3 of 3 staff interviews, 4 of 4 staff file reviews, 0 of 6 client interviews due to clients (C1-C6) not being able to answer questions and 6 of 6 client file reviews. Based on client record review, 6 of 6 client files, the licensee did not have a current court order, or a written authorization of the clients (C1-C6) parent or guardian, for each psychotropic medication and 6 out of 6 client medication logs did not have a separate log for each psychotropic medication prescribed to the client(C1-C6), which poses a potential health, safety or personal rights risk to persons in care. The facility is being issued a citation in accordance with the Title 22, Section 83070(b) (11) & Section 84070(b)(13). See LIC809-D dated 01/21/22 for the cited deficiency. An exit interview was conducted, and this report, appeal rights and LIC 811 was reviewed with Program Administrator Jonathan Sparhawk.

met_with: Jonathan Sparhawk


summary: Facility Evaluation

raw_content:
Narrative:
On January 23, 2023 at 9:00 am, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced required annual inspection of Emmanuel Family Home and met with Facility Administrator Jonathan Sparhawk. The home is a one story residence with 5 bedrooms and 2 bathrooms. The facility currently serves six clients. LPA inspected the facility interior and exterior. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The living room consists of a television with a spacious living room and three couches. Bedrooms are furnished and have adequate shelf and closet space for client's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed clean bath towels, and washcloths available for clients. The bathrooms were clean and in good repair. The facility has air conditioner throughout the house and maintained at a comfortable temperature. Hot water temperature measures 115.0 degrees. There are no weapons or firearms at facility. Medications and First Aid kit are locked and centrally stored dining room/ office cabinet. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. All hazardous items have been properly made inaccessible to areas where clients will have access. Cleansers/chemicals are locked and stored under the sink. Sharp knives are inaccessible and stored in a locked cabinet in the dining/ staff area. The facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The last emergency disaster drill was conducted on 12/18/22. The facility maintains at least one week supply of nonperishable foods, snacks, and at least two day supply of perishable foods. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, and current menu. (see continuation form LIC-809C dated 01/23/23) LPA reviewed Physical Plant, Operations, Disaster Preparedness, and Emergency Intervention. LPA conducted staff and client file reviews and interviews. LPA conducted 2 of 2 staff interviews, 2 of 2 staff file reviews, 0 of 6 client interviews due to clients (C1-C6) not being able to answer questions and 6 of 6 client file reviews. Based on the facility inspection and file reviews conducted, there are no deficiencies found at this time. A exit interview was conducted. A copy of this report was reviewed and given to Jonathan Sparhawk, Program Administrator along with appeal rights and Confidential Names List (LIC 811).