summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2022 at 9: AM, Licensing Program Analyst (LPA) Jessica Peete, conducted an unannounced annual inspection at River Stone Child and Adolescent Treatment Group Home. LPA was met at the facility by Program Manager Lenier Lee. LPA began a physical plant inspection at 9: AM assisted by the Program Manager. LPA inspected the facilities main building which included: The kitchen, dining room, common room, refrigerator/freezer, two client bathrooms and three client bedrooms (B1,B2, B3). Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. Each client room has the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, there is adequate drawer and storage space for each client's belongings. On the facility grounds located at the back of the facility, LPA inspected, the conference room, food storage area, refrigerator/freezer, one staff bathroom and three staff offices (Clinical Program Manager, Therapist and, office of the Chief Executive. ) Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in the kitchen cabinet. The cooking knives are in a lock box; locked inside the kitchen cabinet. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven-day non-perishable and a two-day perishable supply of food. Additionally, LPA observed the following postings: facility license, grievance procedures, personal rights, Ombudsman poster, visitation policies, and current menu. Age appropriate toys, games and books were observed for client's recreation time. The facility's outside grounds were also inspected and found to be clean, well maintained, and free of observable hazards. There are no pools or other bodies of water on the property. There is adequate indoor and outdoor activity space; all exits, and walkways were free from obstruction. Per Program Manager there are no guns or weapons on facility grounds (Continued on LIC C) The hot water in each client bathroom measured within 105-120 degrees Fahrenheit. The facility has an operable carbon monoxide detectors and smoke detectors located throughout the facility. The fire extinguisher is properly charged, serviced, and located in the Kitchen. Medications were centrally stored in a locked kitchen cabinet inside of a lock box. The First Aid Kit is complete and also stored in a lock box in the kitchen cabinet. The washer and dryer are located in the back of the facility, next to the conference room, and accessible to clients with staff assistance. Per Program Manager's statement clients are supervised while they do their own laundry and LPA observed detergents are kept locked. At 11: AM, assisted by the Clinical Program Manager Judy Canales, LPA began review five client records (C1-C5) All documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. At 12: PM, assisted by the Program Manager, LPA began review of the Disaster Preparedness, Operational Requirements, Emergency Interventions. At 1: PM, LPA observed the licensee did not have procedures that address, the storage and preservation of medications. The licensee was cited with a technical violation of the Health and Safety Code (HSC) 1565(a)(7)(E). The regulation is stated as follows: (a) A facility shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (7) Procedures that address, but are not limited to, all of the following: (E) Storage and preservation of medications, including the storage of medications that require refrigeration. Based on observations, made during the inspection, no deficiencies are being cited. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and appeal rights was provided to Program Manager Lenier Lee.

met_with: Program Manager Lenier Lee


state: CA

facility_name: RIVER STONES CHILD AND ADOLESCENT TREATMENT, INC

summary: Facility Evaluation

raw_content:
Narrative:
On December 9, 2022 at 9: AM, Licensing Program Analyst (LPA) Jessica Peete, conducted an unannounced annual continuation visit at River Stones Child and Adolescent Treatment Inc Group Home. LPA was met at the facility by Program Manager Lenier Lee. LPA Peete visited the facility on 12/08/2022 to complete inspection of the Physical Plant, Disaster Preparedness, Operational Requirements, and Emergency Interventions. At 9: AM, assisted by the Program Manager, LPA began the review of five staff files (S1-S5). No deficiencies were noted however, licensee was cited for the following technical violations: California Code of Regulations (CCR) 84065(i)(3)(V) ...new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (V) A child's right to receive sexual and reproductive health care and information. CCR 84065(i)(3)(X) .... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (X) The duties and responsibilities of the assigned case management worker and the licensee to ensure that children can obtain sexual and reproductive health services and information. CCR 84065(i)(3)(Y)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (Y) Guidance about how to engage and talk with children about healthy sexual development and reproductive and sexual health in a manner that is medically accurate, age or developmentally appropriate, trauma informed, and strengths based. (Continued on LIC C) CCR 84065(i)(3)(Z) ... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (Z) Information about current contraception methods and how to select and provide appropriate referral resources and materials for information and service delivery. During the record review LPA observed staff was hired prior to the effective date of the regulation 10-01-2022. However, the licensee has not updated staff training to include the required information as cited above and on the LIC 809 . At 2: PM LPA conducted two staff interviews (S1, S4). Based on observations, from today's visit, no deficiencies are being cited. An exit interview was conducted and a copy of this report and appeal rights were given to Program Manager Program Manager Lenier Lee.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
***This is an amended report of the report regarding the annual inspection conducted on October 22, 2024. The date of the report was incorrectly recorded. The inspection occurred on 10/22/24, as reflected in the narrative.*** On October 22, 2022 at 8: AM, Licensing Program Analysts (LPAs) Jason Dalton and Daniel Mena conducted an unannounced annual inspection at River Stone Child and Adolescent Treatment Group Home. LPAs were met at the facility by Program Manager, Lenier Lee. LPAs began a physical plant inspection at 9: AM assisted by the Program Manager. LPAs inspected the facilities main building which included: The kitchen, dining room, common room, refrigerator/freezer, two client bathrooms and three client bedrooms (B1, B2, B3). Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. Each client room has the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, there is adequate drawer and storage space for each client's belongings. On the facility grounds located at the back of the facility, LPAs inspected, the conference room, food storage area, refrigerator/freezer, one staff bathroom and three staff offices (Clinical Program Manager, Therapist and, office of the Chief Executive.) Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in the kitchen cabinet. The cooking knives are in a lock box; locked inside the kitchen cabinet. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven-day non-perishable and a two-day perishable supply of food. Additionally, LPA observed the following postings: facility license, grievance procedures, personal rights, Ombudsman poster, visitation policies, and **Continued on LIC C** ***Continued from Previous Page***This is an amended report of the report regarding the annual inspection conducted on October 22, 2024. The date of the report was incorrectly recorded. The inspection occurred on 10/22/24, as reflected in the narrative.*** current menu. Age appropriate toys, games and books were observed for client's recreation time. The facility's outside grounds were also inspected and found to be clean, well maintained, and free of observable hazards. There are no pools or other bodies of water on the property. There is adequate indoor and outdoor activity space; all exits, and walkways were free from obstruction. Per Program Manager there are no guns or weapons on facility grounds. The hot water in each client bathroom measured within 105-120 degrees Fahrenheit. The facility has an operable carbon monoxide detectors and smoke detectors located throughout the facility. The fire extinguisher is properly charged, serviced, and located in the Kitchen. Medications were centrally stored in a locked kitchen cabinet inside of a lock box. The First Aid Kit is complete and also stored in a lock box in the kitchen cabinet. The washer and dryer are located in the back of the facility, next to the conference room, and accessible to clients with staff assistance. Per Program Manager's statement clients are supervised while they do their own laundry and LPA observed detergents are kept locked. LPAs were assisted by the Clinical Program Manager Judy Canales, LPAs reviewed five client records (C1-C5) All documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. Based on observations, made during the inspection, no deficiencies are being cited. An exit interview was conducted, and a copy of this report and appeal rights was provided to Program Manager Lenier Lee.

visit_type: Annual

met_with: Lenier Lee


summary: Facility Evaluation

raw_content:
Narrative:
On October 31, 2022 at 9: AM, Licensing Program Analysts (LPAs) Jason Dalton arrived at River Stones Child and Adolescent Treatment Group Home, and met with Program Manager, Lenier Lee. LPA met with Program Manager for the purpose of amending the Annual Inspection dated 10/22/24.

met_with: Program Manager, Lenier Lee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers conducted a case management inspection Wednesday, August 13, 2025, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 13 out of Direct Care Staff and 6 out of 6 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 6 youth were interviewed. (See the Confidential Names List, LIC 811, dated August 13,2025). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Latricia Rogers observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Lenier Lee- Administrator.

met_with: Lenier Lee- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 20, 2026, at 12: PM, Licensing Program Analyst (LPA) Raina Perez-Diaz, arrived unannounced to River Stone Child and Adolescent Treatment, INC. and met with Lenier Lee, Administrator. The purpose of this case management is to discuss medication management. While at the facility LPA conducted a health and safety inspection of the facility and no immediate safety concerns were observed. LPA conducted five interviews and gather pertinent documents. A copy of the LIC 809 and the LIC 811 were provided to Lenier Lee, Administrator.

met_with: Administrator- LENIER LEE


facility_name: RIVERSTONE HOUSE, THE

summary: Facility Evaluation

raw_content:
Narrative:
On 9/23/ Licensing Program Analyst (LPA) Jean Stidman met with LaTonya Glover, Administrator. to discuss the license application and provide technical assistance. LPA and administrator discussed accepting children and ensuring compatibility, Guardian and the criminal record clearance procedure, reporting requirements, video camera usage in the facility, and creating children's and staff files. Exit interview conducted and a copy of this report was given to LaTonya Glover, Administrator,on this date

met_with: LaTonya Glover, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an announced Pre Licensing inspection on 10/08/25 at 10am During the inspection LPA met with La Tonya Glover, Administrator, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. There were two staff and no children present at the beginning of the inspection. During the inspection one staff left. Number of staff interviewed one LPA observed the facility has two bedrooms and bathrooms, a living room family room and office. LPA inspected and/or reviewed the following: LPA observed one video doorbell located outside the facility on the front porch which does not record video or audio. Personal Rights posted_yes_ Disinfectants/Cleaning solutions inaccessible yes Refrigerator Temperature at or below 45 degrees F 39 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week yes Fresh perishable foods two days minimum__N/A_ Menu present and posted_yes_ Working telephone_yes_ Carbon monoxide detectors and Smoke Detector _yes_First Aid Kit fully stocked_yes_ Common Room available yes_ Dining area has enough seating with furniture in good condition_yes_ Medication space is available to be centrally stored, locked/inaccessible. Hot Water between 105-120 degree F 138 degrees LPA observed the administrator turned down the hot water heater. Fire Extinguishers purchased 04/04/25. Toilets wash basin, bath and shower fixtures in good repair yes Soap and Paper towels yes_ Laundry Facilities available _yes_ Bedrooms-required linen and furnishings _yes__ Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts__yes_ Facility free of vermin yes Bedroom furniture in good repair yes Operations Complaint Procedures For Youth Posted _No_ Disaster Preparedness Disaster and mass casualty plan updated and available yes_ Emergency Intervention Review of manual restraint log N/A Staff training _yes_ Staffing/Volunteers Number of Staff files reviewed _nine Criminal record clearances verified nine First Aid Certificate_nine Certified Administrators certificate valid and current_yes_ Client Records No Clients files were reviewed. The following items were reviewed for compliance: Administrator Certificate for La Tonya Glover, LIC500, LIC610C and LIC 999. An exit interview was conducted and a copy of this report was left with La Tonya Glover, Administrator

visit_type: Prelicensing

met_with: La Tonya Glover, Administrator


facility_name: RUBY'S PLACE YOUTH VILLAGE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Monica Pavia and Jasmine Cardeno made an announced site inspection, for the purpose of preparing for a prelicensing inspection, at a later date. LPAs met with Facility Manager, Anjelle Skates, who provided a tour of all buildings on the campus. LPAs observed the following items that need to be addressed prior to a prelicensing inspection to be scheduled. 1. Capacity request for Group Home (GH) application must not exceed bedroom space available for children in placement. No more than 2 children shall share a bedroom. 84087(b)(1) 2. Program shall not have more beds for children's use than required for the maximum capacity approved by the licensing agency. 84088(c)(1)(A) 3. LPA will check camera policy with CCL policy department. Cameras are never allowed to be used in lieu of staff supervision. 84078(b) 4. Bunk beds are not allowed for this population. 84088(c)(1)(C) 4. Hot water temperature shall be maintained between 105 and 120 degrees Fahrenheit. 80088(e)(1) 6. All sharps and poisonous cleaning supplies must be kept locked. 80087(g)(1) 7. Dining room must provide necessary space for licensed capacity. 84087.3(a) 8. Extra linens to be made available in children's living quarters. 80088(g) 9. All food must be covered in the refrigerator/freezer. 10. Display Personal Rights, Menus and Complaint Policy/Grievance Forms in each building on campus, accessed by children in placement.

met_with: Anjelle Skates


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia and LPA Jasmine Cardeno conducted a Group Home (GH) prelicensing inspection with Administrator, Helen Ayala and Facility Manager, Anjelle Skates, on above date and time. All buildings were toured at this time. The facility physical plant is not ready for licensure, at this time. Below are a list of items to be corrected on site. Facility will notify LPA(s) when below corrections are completed. An on-site proof of correction inspection will be scheduled at that time. 1. All client medication(s) will be stored in individual bins per client, and kept locked at all times. Including any vitamins. A medication log shall be kept per medication, per month. (Forms to be emailed separately.) 1a. All over the counter (OTC) and/or As Needed (PRN) medications/vitamins will also have a bin separate from the prescribed client's medications. A medication log shall be kept for all OTC/PRN medications, per month. (Forms to be emailed separately.) Prior to licensure, staff will be trained on medication administration & procedures/forms. 1b. Facility to request a waiver for Naloxone (Narcan) to be kept on site at the facility without a prescription, for emergencies only. (Waiver instructions to be emailed separately.) 2. Facility will post foster child's rights (2021) in each common area of each building. 3. All buildings on campus, not occupied with clients and/or not in use, shall be kept locked at all times. 4. There were a couple of locks the staff did not have keys/access to during LPA inspection. Facility is required to allow licensing access to everything, during any type of inspection. (Recommend double set of all keys to be kept on campus.) 5. The weekly schedule posted in the dining room will remove religious services from the calendar days. 5a. The weekly schedule must include snack times. 5b. The menu of food posted must include 2 different snacks per day. (Helen informed they would merge the weekly schedule with the times with the menu of foods.) 5c. Please remove 'ORR' from any posted forms/schedules/documents. 6. Scissors in the classroom must be kept locked at all times. 7. All trash and recycle bins are required to have secure lids. This is for all trash and recycle bins that are throughout the facility campus. 8. LPA(s) observed several hazardous piles of old construction and loose tools, stored behind buildings on campus (accessible to clients). Facility to remove and will conduct a thorough walk through of the property prior to next LPA inspection being scheduled. 8a. LPA(s) observed a sharp decor next to a building on campus, and it poses a safety hazard. Facility will remove from campus. 9. LPA(s) observed an old blue cable lose and not secured, behind several buildings on campus. The cable had been spliced and not in use. Facility to remove cable. 10. LPA(s) observed a water sprinkler hose not secured, and it poses a tripping hazard. Facility will secure hose to ground and cover with existing bark on campus. 11. Facility emergency food supply is expired. Facility to replace emergency food supply, which is not included in the 2-day perishable and 7-day non-perishable foods required. 12. Facility has maximum occupancy signs posted that do not match requested capacity. Facility will get in writing from Hayward Fire Inspector if maximum occupancy signs are required in the GH residential building, referred to as Nancy's House. 13. Facility may not post kitchen closed and/or kitchen hours signs. 14. Facility may not prohibit food inside the GH residential building, referred to as Nancy's House. (Facility may have house rules prohibiting food in client bedrooms.) 15. Nancy's House bathroom has an exposed towel rack fixture that needs to be removed. 16. Nurse's office (separate building on campus) was unlocked during LPA(s) inspection. LPA(s) observed 2 types of vitamins unlocked on the nurse's office. No medication log had been kept either. Nurse to lock & keep own medication logs for OTC/PRN medications, or, they are to be kept with GH/client medications, which are kept locked in the staff office, with medications. 16a. Nurse will request new placement to take pregnancy test, STD test and urine sample (among others) when a client is placed with a known or divulged sexual history. Please add to Program Statement, Section 6, Medical/Dental that no Ruby's Place staff will force any testing on clients, as well as not violate client rights. 17. Confidential phone booth (separate on campus building) must remain locked when not in use. Staff must always have physical line of sight to all clients in placement, therefore, staff will always be available to unlock the phone booth. All staff should have keys/access to all buildings on campus during their schedule shifts. 18. A copy of staff's monthly work schedule is required to be posted in a common area of staff. 19. Staff scheduled for client supervision must remain inside the residential building, referred to as Nancy's House, at all times, when clients are present in the residential building. 20. If clients leave residential building and walk around campus, staff must always physically have client in line of sight at all times. 21. Facility will remove the phone days/times posted on the front door of Nancy's House. The sign must be removed or please add the specific days/times posted that are for international/long distance calls only. All other phone use must not have day/time restrictions posted. 22. Clients have the right to privacy and are allowed to close their bedroom door when they go to sleep. (No windows allowed on bedrooms doors.) If staff are required to maintain 24/7 line of sight, they may do bed checks every hour during client sleep time. A log is required per client, per check. During bed checks, staff are not allowed to turn on client bedroom lights, touch clients (unless it's an emergency) or wake youth. Bed check logs will be kept by month and then stored in client's confidential file.


summary: Facility Evaluation

raw_content:
Narrative:
On May 8, Licensing Program Analyst (LPA) Monica Pavia met with Facility Manager, Anjelle Skates for a prelicensing inspection. LPA discussed the following with Anjelle Skates: Forms that the facility uses and will continue to use. Corporate organization - Including chain of command and roles of staff Written plans, policies or procedures that was submitted with the application. Administrator qualifications and duties. Anjelle Skates is qualified, and will be named the Administrator, once CCL receives approval via Board Resolution or Board Minutes. 1. Facility grounds were inspected. There are several structures on facility grounds. Nancy's House will be ,utilized as the residential house for the Group Home (GH) license, capacity of 6. All buildings/structures on facility grounds, not in use, will be kept locked. Grounds are clean and free from observable hazard. The facility does not have a swimming pool or any bodies of water. Firearms are not allowed on facility premises. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7.Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. Nancy's house has 3 client bedrooms, double occupancy and 1 client bathroom. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of all clients. 13. Hot water measured 110 degrees on this date. Applicant and staff are associated through Guardian and have been fingerprint cleared. Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day, either verbal or written. A full report is to be remitted within 7 days via email to SBIRCR@dss.ca.gov. The submitted Program Statement (PS) is under review. The facility will be ready for licensure, once PS is approved. A copy of this report was given Anjelle Skates.


summary: Facility Evaluation

raw_content:
Narrative:
On January 30, 2025 at 10:AM Licensing Program Analyst (LPA) Shikya Belfield met with Administrator, Anjelle Skates for a pre-licensing inspection. LPA attempted to utilize the CARE TOOL, however due to technical issues with equipment, they were not able to use the CARE TOOL. LPA discussed the following with Anjelle Skates: Administrator and facility manager roles. LPA reviewed written plans, policies or procedures that was submitted with the application. Administrator qualifications and duties. 1. Facility grounds were inspected. There are several structures on facility grounds. Facility was previously licensed for a capacity of Six and they have requested a capacity increase to 16. Grounds are clean and free from observable hazard. The facility does not have a swimming pool or any bodies of water. Firearms are not allowed on facility premises. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. House has 4 client bedrooms, double occupancy and 2 client bathrooms. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space and dining observed. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of current clients. Additional dinning and activity space is being created to accommodate the increase in capacity. Proof of additional space to accommodate the increase will be sent to the department prior to license being issued. Applicant and staff are associated through Guardian and have been fingerprint cleared. LPA observed one staff who does not have criminal record clearance, this staff is in the process of obtaining clearance and has no contact with clients according to administrator. Clearance will be obtained before any work will be completed in the facility or any work with clients according to the California Code of Regulations. Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day, either verbal or written. A full report is to be remitted within 7 days via email to SBIRCR@dss.ca.gov. The submitted Program Statement (PS) is under review to ensure it follows regulations according to the increase in capacity. The facility will be ready for license, once PS is approved and proof if additional space is submitted. There were no violations of the California Code of Regulations, Title 22, Division Six, cited during this inspection. A copy of this report was given to Administrator. Anjelle Skates.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/11/2025 at 11:35 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Anjelle Skates, Administrator. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. LPA Rodriguez used the CARE Inspection Tool. The facility currently has a census of one client. LPA Rodriguez reviewed five (5) staff files, two (2) client files, LPA Rodriguez also reviewed the emergency disaster plan binder. LPA Rodriguez conducted two (2) confidential staff interviews and one attempted (1) confidential client interview. Client did not want to get interviewed. During physical plant inspection, no deficiencies were found. LPA Rodriguez toured the facility inside and out. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and full-sized beds. Each bedroom has drawers for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. Extra linens are located in a closet in the hallway. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. The weekly menu was posted. No bodies of water on the premises. All walkways were free from debris or hazards. LPA toured the backyard and observed it to be free from hazards. The required Annual Inspection is complete. No deficiencies were cited. An exit interview was conducted at 3:05 p.m., and a copy of this report was printed and given to Administrator Anjelle Skates, whose signature on this form confirms receipt.

met_with: Anjelle Skates, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/03/2025 at 1:50 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez met with Daniela Lemus, Case Manager, and Brenda Garcia Rios, Case Manager regarding an incident report that was reported to CCL on 11/19/2025. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 11/19/2025. More information on Incident Report on LIC 812. LPA Rodriguez conducted one (1) confidential staff interview. An exit interview was conducted, and a copy of this report was given to Case Manager Daniela Lemus, whose signature on this form confirms receipt.

met_with: Daniela Lemus, Case Manager & Brenda Garcia Rios, Case Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/17/2025 at 11:00 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Kaitlyn Wong met with Monse Ayala, Youth Advocate, regarding an incident report that was reported to CCL on 11/19/2025. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 11/19/2025. More information on Incident Report on LIC 812. LPA Rodriguez conducted one (1) confidential client interview. An exit interview was conducted, and a copy of this report was given to Youth Advocate Monse Ayala, whose signature on this form confirms receipt.

met_with: Monse Ayala, Youth Advocate


summary: Facility Evaluation

raw_content:
Narrative:
On 11/12/2025 at 10:00 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Kaitlyn Wong met with Anjelle Skates, Administrator, regarding an incident report that was reported to CCL on 10/30/2025. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 10/30/2025. More information on Incident Report on LIC 812. LPA Rodriguez conducted two (2) confidential staff interview and one (1) confidential client interview. LPA Rodriguez cited a Type B Citation for Personnel Duties 84065.2(b)(1), see more on LIC 9099D. An exit interview was conducted at 11:35 a.m., and a copy of this report was printed and given to Administrator Anjelle Skates, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/25/2026 at 12:30 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Inspection and met with Anjelle Skates, Administrator. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. The facility currently has a census of zero clients. LPA Rodriguez did a walk through to make sure there are zero clients due to the facility being closed. At the time of the inspection, LPA Rodriguez left the Forfeiture Letter with Administrator. Administrator gave LPA Rodriguez their license as well. An exit interview was conducted at 1:15 p.m., and a copy of this report was given to Administrator Anjelle Skates, whose signature on this form confirms receipt.


facility_name: S & A CHILDREN'S CARE SERVICES, INC.

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On October 21, Licensing Program Analyst (LPA) Rachel Bruce conducted a follow up complaint inspection for the purpose of delivering the findings for the above complaint allegations. LPA met with Administrator Susanna Mkhitarian. The investigation included confidential interviews; inspection of the facility and review of documentation in both client and staff files. The complaint alleged the Administrator did not purchase new clothes for clients, that the meals served to clients are not freshly prepared and the Administrator uses profanity in front of the clients. Parties interviewed provided conflicting information regarding these issues. Although the allegations may have happened or may be valid, based on confidential interviews, inspection and documentation reviewed, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are deemed to be UNSUBSTANTIATED at this time. November 14, LPA arrived at the facility to amend the findings. This document reflects the correct findings for the above allegations. An additional separate Substantiated finding is being added on today's date (see 9099 dated 11/14/22) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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

report_type: Complaint Investigation

met_with: Susanna Mkhitarian, Administrator

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On November 14, 2022, Licensing Program Analyst (LPA) Rachel Bruce conducted a follow up complaint inspection for the purpose of delivering the amended finding for the above complaint allegation. On February 1, 2023, LPA met with Administrator Susanna Mkhitarian and the previous substantiated finding is being amended on today's date to reflect unsubstantiated. The complaint alleged the Administrator does not spend money on activities. The complaint investigation included an inspection of the facility, record review and confidential interviews. Parties interviewed provided conflicting information regarding the above allegations. Although the allegations may have happened or may be valid, based on the investigation, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation above is deemed to be UNSUBSTANTIATED at this time. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: S & A CHILDREN'S CARE SERVICES, INC.FACILITY NUMBER: 107206730


raw_content:
Investigation Findings:
13On December 30, 2022, Licensing Program Analyst (LPA) Rachel Bruce conducted a follow up complaint inspection to the S & A Group Home Foster Family Agency (FFA) and met with Susanna Mkhitarian, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. While conducting a physical inspection of the home on September 20, 2022, LPA noted mold on the shower curtain. Based on confidential interviews and record review it was determined that a staff person worked at the facility before being cleared to work with children. based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Deficiencies were cited. A copy of the report was provided to the Administrator along with appeal rights. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: S & A CHILDREN'S CARE SERVICES, INC.FACILITY NUMBER: 107206730


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analysts (LPA's) Sonia Sanchez and Miriam Flores, conducted a complaint inspection and met with Susanna Mkhitarian, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. Based on interviews it was determined that the agency is not reporting incidents, youth not being accorded their personal rights, and youth not being provided communication device. Based on the LPA's observations, confidential interviews and records review which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A deficiency is being cited for the Interim Licensing Standards (ILS) Chapter 8.8, Articles 9, Section 84061(1) Reporting Requirements, 84072(d)(1) and 84072(d)(28) Personal Rights. Exit interview and a copy of the report and Appeal Rights was provided to Susanna Mkhitarian, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Sonia Sanchez 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: S & A CHILDREN'S CARE SERVICES, INC.FACILITY NUMBER: 107206730

met_with: Susanna Mkhitarian


summary: Facility Evaluation

raw_content:
Narrative:
On 06/29/ An unannounced annual inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco and CS (Complaint Specialist) Charles Kinney at S&P Group Home. LPA's met with Susanna Mkhitarian and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors appear to be in appropriate working order, fire extinguisher is properly charged. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 78 degrees. Facility has cameras in common areas of the facility. Administrator Susanna Mkhitarian is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 facility managers and 3 direct care staff. 4 records of personnel/ staff members were reviewed with Susanna Mkhitarian to ensure staff meet regulatory requirements. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site. 4 records of clients were reviewed with Susanna Mkhitarian. LPA discussed the following with the Administrator: Record keeping, including TB, first aid certification. There were no deficiencies cited on this date. A technical Violation was issued on Title CCR regulation 80075 (f).


summary: Facility Evaluation

raw_content:
Narrative:
On September 20, 2022, Licensing Program Analyst (LPA) Rachel Bruce traveled to the S&A Group Home located in Fresno CA for the purpose of conducting an unannounced Annual Inspection. LPA met with Administrator Susanna Mkhitarian and inspected the facility, inside and out. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 72 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. No firearms or weapons are allowed in the facility. There is no pool and no pets at the facility. LPA reviewed client and staff files. LPA interviewed two staff. Clients are all non-verbal so no interviews were attempted. All required forms are posted. Client and staff records are stored in locked cabinets. Clients had adequate storage and individual beds were observed. r. No deficiencies were issued at this visit.


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2023, Licensing Program Analyst (LPA) Rachel Bruce traveled to the S&A Group Home located in Fresno CA for the purpose of conducting an unannounced Annual Inspection. LPA met with Administrator Susanna Mkhitarian and inspected the facility, inside and out. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 72 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. No firearms or weapons are allowed in the facility. There is no pool and no pets at the facility. Client bedrooms met regulations, had adequate storage, individual beds were observed and rooms were free of clutter and clients had adequate and appropriate clothing. LPA reviewed client and staff files which are stored in locked cabinets. LPA interviewed two staff. There are currently Clients which are non-verbal so no interviews were attempted. Current staff are all appropriately finger print cleared and associated to the facility. No deficiencies were issued at this visit, 4 technical advisories were issued pertaining to the records maintained in the emergency binder. Facility will ensure the needed information from the client binders is copied and maintained separately for emergency purposes.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
An unannounced annual inspection was conducted by LPAs (Licensing Program Analysts) Reyna Martinez and Brinae Pointer. LPAs met with Susanna Mkhitarian, Administrator and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced April 19, 2024. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable foods. The facility is maintained at 76 degrees. Hot water temperature measures 105 degrees. Facility has cameras in common areas of the facility. No firearms or weapons are allowed in the facility. No pools. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 administrator, 1 office manager, 1 house manager and 11 direct care staff and 1 behavior specialist. 1 staff was available to be interviewed. Two clients available to be interviewed. Clients in the facility are all intellectually disabled and non-verbal. An attempt was made to make communication. Staff files were reviewed. 2 records of clients were reviewed. Five deficiencies and three technical advisory's were cited on today's visit on the attached LIC809-D and LIC9102TV Page. A copy of this report and appeal rights was left at the facility

Deficiencies:
80026(h): Safeguards for Cash Resources, Personal Property, and Valuables

(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Briana Placencia on February 12, 2025 at 12: PM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Susanna Mkhitarian, Administrator and inspected the facility inside and out. LPA reviewed 1 child record and 2 staff personnel files on site at the facility. LPA reviewed 1 child psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA was unable to conduct any interviews with the child currently on psychotropic medication due to the child being in school. LPA will interview child at a later time. LPA provided a copy of this licensing report to Susanna Mkhitarian, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Susanna Mkhitarian, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 07/03/2025, Licensing Program Analysts (LPA's) Sonia Sanchez and Miriam Flores, travelled to S & A Children's Care Services, Inc to conduct an unannounced Required Annual inspection. LPAs met by Administrator, Susana Mkhitarian and Assistant Administrator Sergy Hakopyan. No firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. LPA reviewed 1 client files and 5 staff files. At 10:40AM, an inspection of one client file was conducted as well as the centrally stored record and medications. At 11:00AM, staff records were inspected. At 12:30PM, an inspection of the physical plant was conducted. LPA observed adequate food supply, adequate bedding, storage space, activity space, hot water that measured 105 degrees, and all required postings were posted in the living room area. Facility is safe, sanitary and in good repair. Facility has Fire Extinguisher that was serviced on 12/12/2024. The exit interview was conducted at 1:30PM and a copy of this report given to the Administrator. At 1:10PM, an interview with S1 (see LIC811 dated 03/20/2024) was conducted One Technical Assistance (See LIC-9102) on this date. Exit interview was completed with the Administrator and House Manager. A copy of this report and appeal rights were left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Sonia Sanchez traveled to S&A Children's Care Services as a follow up to the unannounced Required Annual Inspection that was completed on 07/03/2024 and met with Susana Mkhitarian, Administrator. The purpose of the visit was to complete an additional staff interview in order to meet the requirements for completion of the Required Annual Inspection and to discuss the All County Letter (ACL 2450) vs. PIN (24-09-CRP) for Camera Surveillance. LPA discussed with Administrator and provided a copy of the PIN, as well as a copy of this report to Susana Mkhitarian, Administrator at the Group Home.

met_with: Susana Mkhitarian, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on 03/02/2022 at 9:30AM. During the inspection, LPA Melikian met with Susanna Mkhitarian, Administrator and inspected the facility inside and out. LPA reviewed three children's records on site at the facility at 10:00AM. LPA reviewed two staff personnel records on site at the facility at 10:45AM. LPA reviewed three children's psychotropic medications and medication records at 11:00AM. LPA interviewed two staff at 11:30AM. LPA did not interview any children. One child was a private placement and the other two children were nonverbal. LPA conducted exit interview with Susanna Mkhitarian, Administrator at 12:00PM. LPA provided the summary report to Susanna Mkhitarian, Administrator upon completion. Deficiency on the attached page.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Tamara Melikian and Jessica Rodriguez on February 9, 2023 at 12:30PM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPAs met with Jessica Valle, Office Manager, and inspected the facility inside and out. Administrator became ill on this date and was not present but will be contacted at a later time. LPAs reviewed 2 child's records and 2 staff personnel files on site at the facility. LPAs reviewed 2 child's psychotropic medications and medication records. LPAs interviewed 1 staff on site to discuss the facilities policies and procedures of operation. The administrator was ill and will be interviewed at a later date. During the inspection the LPAs observed deficiencies (see attached 809D), plan of corrections were discussed and appeal rights were provided. LPAs provided a copy of the licensing report to Jessica Valle, Office Manager.

met_with: Jessica Valle


facility_name: SAFE HOUSE EMERGENCY SHELTER

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
interviews on 12/20/23, 1/31/24 and 3/5/24 with two clients and three staff. Three out of seven records reviewed revealed the facility did not document the self-administration of prescription and nonprescription medications. The medication records shows the facility did not document the time one medication was given to the client on 12/5/23, and two other medications for another client are missing the reason it was not administered on 9/27/23-9/28/23, 9/30/23-10/1/23, 10/3/23, 10/8/23 and 1/6/24. During one interview an administrative staff reported they changed an incident report due to "grammatical and punctuation errors and extra information that did not pertain to the incident." Based on LPA's interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division Six, Regulation 80075(b) Health Related Services, and 80061(b)(1)(E) Reporting Requirements are being cited on the attached LIC 9099D." Exit interview conducted and a copy of this report and a copy of the appeal rights were left at the facility with Amy Powers, Youth Services Program Director.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced inspection to the facility on 4/5/24 at 12:45pm to deliver complaint allegation findings. LPA met with Amy Powers, Youth Services Program Director and discussed the above allegations. During the investigation of medication errors, and facility not reporting incidents adequately, LPAs Jean Stidman and Janie Davis toured the facility with Amy Powers Youth Services Program Director on 12/20/23 and LPA Stidman on 1/31/24 with Amy Powers, and 3/5/24 with Chelsi Gaspin. On these inspections, LPA(s) inspected the physical plant inside and out. LPAs observed the facility is a single story four bedroom and a two-bathroom home. LPA Stidman reviewed two client files on 12/20/23, 1/31/24 and 3/5/24 and obtained documentation for the complaint investigation of Safe House Shelters client intake, Safe House Shelter Service Check Form, Safe House PRN Form, Parent Guardian Information, Medical Information, seven clients Medication Administration Records for September- December 2023 and a copy of the menu for 1/29/24 and 2/5/24, discharge form, Exit/Aftercare Plan, Outcomes Form, and Parent/Guardian Information. LPA conducted SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SAFE HOUSE EMERGENCY SHELTERFACILITY NUMBER: VISIT DATE: 04/05/2024

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

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On February 16, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility for the purpose of conducing a required/annual inspection of the facility. LPA met with Amy Powers, Program Director and began the required/annual inspection of the facility. The facility is an Emergency Shelter/Group Home, that offers short-term and emergency shelter and services to youth ages 12-17 years old. The facility is a single-family home, consisting of four client bedrooms and two bathrooms. Currently, there are a total of two clients in care. The client bedrooms were observed to contain an individual bed, clean and extra blankets and linens, and storage space for client property. LPA completed a physical inspection of the facility. The facility was observed to be clean, organized, and free of debris and clutter. The facility also contained a living room, a kitchen, dining room. The dining room had a table for up to six clients to sit and eat, and complete activities and homework. The facility license, facility sketch, and fire clearance were observed to be posted in a prominent place. The fire extinguisher was observed to be located in a prominent location and was charged, up-to-date and was last serviced in the last year, in March 2021. The facility has a closed security system inside and outside of the facility, with two camera inside (the dining area and the kitchen) and with one camera facing the front porch, and one camera faces the back porch. The security camera monitor is located in the dining room on the staff desk. continued on 809-c The facility has a detached garage, that is used for storage. The Operations Manager has access to the garage and unlocked for inspection. LPA observed the garage held tools, furniture, storage, recreational equipment, holiday storage items, and extra bed frames. The facility has a shed on the premises, that is utilized for a separate program and the facility staff and clients do not access. LPA observed the laundry room was locked and stored the locked medication, cleaners, and extra linens and towels. There was a locked cabinet in the kitchen that held extra toiletries and locked sharps. The refrigerator and freezer and pantry held enough perishable and nonperishable food in the home in a quantity to meet the needs of the next three meals and the between meal snacks for clients in care. The facility has baby formula on site for clients', who have infants, use. Upon review of the pantry items, and expiration dates, LPA observed many items, including canned goods, bagged goods, bread items, and boxed items, were expired between the years 2020-2022. LPA removed the items and informed the staff that they were expired and asked staff to discard them. LPA also observed multiple bags of nuts and grains on the pantry shelf that had live bugs, observed to be maggots, inside of them. The staff was informed and immediately discarded the food. The facility Director stated that there is a process in place for staff to inventory and discard expired foods during the graveyard shift and will follow up with the staff to ensure this does not happen again. A first aid kit was observed and inventoried. The first aid kit was low, and staff reported that they requested a new one for the facility in January 2022, and will follow-up to ensure it is replaced. The first aid kit was missing a first aid manual manual and roll of gauze. See TV. The facility smoke alarms (hard-wired) and carbon monoxide detector(s) are present and were tested and are in working condition. The facility did not have complaint procedures or forms posted in the facility, accessible to children. See TV. continued on 809-c During the course of the inspection, LPA reviewed two client files and observed that the files contained all of the required documentation. However, the facility's policies and procedures document, was not signed by the client or their authorized representative/guardian and did not include information on the facility's discipline or complaint policy and process. See TV. One out of two clients in care are prescribed and administered medication. Client medication was observed to be locked and medication administration documentation was in compliance with CCL regulations, however the MAR form for Psychotropic medication that one client takes, were not completed on the correct form. See TA. The client file had a signed medication consent regarding authorization to administer medication, but does not specifically mention or state it is for the authorization of Psychotropic Medication. See TA. The facility Director, Operations Specialist and staff interviewed stated that fire drills and other training have been completed regarding fire safety topics, did not have documentation to provide to LPA of emergency drills being completed and documented at the facility. An interview was conducted with one staff member. There were no clients present in the facility at the time of the inspection, and interviews could not be completed. LPA was unable to complete the annual inspection on today's date and will return to complete the inspection on a separate date, including the review of staff files. The facility is out of compliance with 80076(a)(17) and 80023(d)(2). The facility is being cited for deficiencies of California Code of Regulations, Title 22, section 80076(a)(17), and California Code of Regulations, Title 22, section 80023(d)(2),which poses a potential health, safety or personal rights risk to persons in care. See 809-D for citation and Plan of Correction information. An exit interview was conducted with Amy Powers. A copy of this report, and appeal rights, were reviewed and provided to Amy Powers.

met_with: Amy Powers, Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 3/27/23 at 2: PM Licensing Program Analyst (LPA), Kim Pawlowicz arrived at the facility to conduct an unannounced annual inspection. LPA phoned office staff to be let into the facility. LPA was greeted at the door by Jessica Williams Support Specialist/Trainer. The facility is an emergency shelter caring for clients 12- 17 years old. A tour of the facility was given by Natalie Lopez, Youth Shelter Coordinator. The outside of the facility was clean, free of debris, with no safety hazards observed. The facility is a one story home with four bedrooms and two baths. Each room has beds with linen, dressers, and closet space with adequate space for personal belongings. Personal hygiene products are available for clients to use. The kitchen is clean and organized and has food in the refrigerator with surplus in the pantry. A living room with tv and games is used for activity space. Chemicals are locked in a cabinet in the kitchen area. Medications are stored in the laundry room in a locked safe. Client files are in a locked filing box in the office area. Smoke/Carbon detectors and fire extinguishers are in working order. There are no firearms or bodies of water/pools on site. The inspection tool was partially completed. One client file was reviewed and one client was interviewed. A subsequent visit will be needed to complete this annual/required inspection. No Title 22 deficiencies were cited at today's inspection. An exit interview was conducted and a copy of this report was left with Natalie Lopez, Youth Shelter Coordinator.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/14/23 at 10: AM Licensing Program Analyst (LPA) Kim Pawlowicz arrived at N San Joaquin Street (Prevail's Administration building) to meet with Corina Marquez, HR Manager to review staff files for the purpose of completing the annual inspection that was initiated with the above-named agency on 3/27/23. LPA reviewed five personnel files. LPA then drove to Safe House Emergency Shelter on Flora Street to complete the inspection tool and to interview three staff who were present on site. No youth were present at the facility during the time of the inspection. The facility is being cited for missing health screening/TB and expired first aid/cpr certifications. Appeal rights were discussed and and provided. An exit interview was conducted and a copy of this report was left with Natalie Lopez, Youth Shelter Coordinator .


summary: Facility Evaluation

raw_content:
Narrative:
On 5/3/23 at 12: PM Licensing Program Analyst (LPA) Kim Pawlowicz arrived unannounced to the above named agency for the purpose of initiating a case management visit and met with Natali Lopez to discuss two incidents involving medication distribution. LPA requested copies of youth's intake and medication forms. LPA also requested training certificates for one staff. Youth Shelter Coordinator will email training certificates to LPA as they are housed in another building. A tour of the facility was given by Natali Lopez. LPA inspected medication lock box, Medication Count Log, and Medication Binder. There were no deficiencies cited during this inspection. Further information is needed. An exit interview was conducted and a copy of this report was given to Natali Lopez, Youth Shelter Coordinator. .

met_with: Natali Lopez, Youth Shelter Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On 5/30/23 at 4: PM Licensing Program Analyst (LP) Kim Pawlowicz made an announced visit to the above named facility for the purpose of observing staff perform a medication count. This is a collateral visit in connection with a case management visit from 5/3/23. Five youth were present at the facility and one youth was offsite at a doctor's appt. LPA met with Jessica Williams, Shelter Coordinator and Yasmin Garcia, Program Shelter Specialist No deficiencies were noted during this visit.

met_with: Jessica Williams, Shelter Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On 3/7/ Licensing Program Analyst (LPA) Jean Stidman met with Isabel Rios Director of Administration for the purpose of a Case Management inspection. No clients were present. LPA arrived at the office located at North San Joaquin Street, Stockton, CA. 95202. LPA obtained documentation of Administrator Certification application for one staff of the LIC508, completed criminal record clearance, the LIC9214 and fees were submitted to the Administrator Certification Bureau on 2/29/24. Further investigation is needed. A copy of this report was reviewed and left with Isabel Rios Director of Administration.

met_with: Isabel Rios Director of Administration


summary: Facility Evaluation

raw_content:
Narrative:
On 3/20/ Dara Campos Licensing Program Manager (LPM), Jean Stidman Licensing Program Analyst (LPA) conducted an Informal conference with Krista Fiser CEO, Chelsi Gapasin Program Manager, Isabel Rios Director of Administration,Eliana Montes Program Coordinator, and Amy Powers Director of Youth Services for the purpose of a Case Management inspection. LPM and LPA discussed the concerns that CCLD has observed and to provide comprehensive technical assistance to assist the facility in providing a successful program. Areas of Discussion/Concerns a. Program Statement b. Qualifications c. Requested Documentation d. Medication e. Services Available to Youth f. Care and Supervision g. Food Services h. Operating Hours No violations were cited. A copy of this report was provided to Isabel Rios Director of Administration


summary: Facility Evaluation

raw_content:
Narrative:
On 4/8/ Licensing Program Analysts (LPAs), Jean Stidman and Angelique Hill met with Chelsi Gapasin Youth Services Program Manager, for the purpose of providing technical assistance on medication administration and the documentation of medication administration. LPAs provided technical assistance to 21 agency staff. No violations were cited during today's inspection. A copy of this report was reviewed and left with Chelsi Gapasin Youth Services Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/22/ Licensing Program Analysts (LPAs), Jean Stidman and Angelique Hill met with Chelsi Gapasin Youth Services Program Manager and Sherranda Turner, Youth Shelter Program Coordinator, for the purpose of providing technical assistance on incident reporting and the documentation of incident reporting. LPAs provided technical assistance to13 agency staff. No violations were cited during today's inspection. A copy of this report was reviewed and left with Chelsi Gapasin Youth Services Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/15/ Licensing Program Analyst (LPA) Jean Stidman met with Krista Fiser CEO, Chelsi Gapasin Program Manager, Isabel Rios Director of Administration, Eliana Montes Program Coordinator, and Stephanie Player Program Director for the purpose of a case management inspection. On 5/15/24 the facility submitted three incident reports by email for incidents that occurred on 5/1/24, 5/6/24, and 5/7/24. These reports should have been submitted to Community Care Licensing Division within seven days from the date of the occurrence. No citations were issued. A copy of this report was given to Krista Fiser CEO.

met_with: Krista Fiser CEO


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Avelina Martinez made an unannounced Annual inspection on 9/10/24 at 10am During the inspection LPAs observed two staff and one child were present in the facility. LPAs met with Sherranda Turner, Program Coordinator, and Chelsi Gapasin, Youth Serivecs Program Manager, who assisted with the inspection. LPAs conducted a walk-through of the facility. Number of staff interviewed one Number of child interviewed one LPAs observed the facility is a single story home with #4 bedrooms, #2 bathrooms LPAs inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights__No Disinfectants/Cleaning solutions inaccessible__X__ Refrigerator Temperature at or below 45 degrees F 50 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Menu present and posted__X__ Working telephone __X_ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __No_ Medication centrally stored, locked/inaccessible _No_ Fire Extinguishers inspected April 2023. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _No Soap and Paper towels __No_ Laundry Facilities(available) __X_ Bedrooms-required linen and furnishings __No___ Facility free of vermin _X__ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation Fixtures, Furniture Equipment and Supplies, Health and Safety Code 1522(c)(1), 80076(a) Food Services, 80075(k)(1) Health Related Services, and 80087(a) Buildings and Grounds on the attached LIC809D. Exit interview conducted and a copy of this report and appeal rights left with Sherranda Turner, Program Coordinator.

Deficiencies:
80076(a): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above by the facility dishwasher has mold growing inside and is not currently being used.
80088: Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited the floor around the toilet in the staff bathroom has tile that has tile peeling, is soft/flexible and appears to have water damage.

met_with: Sherranda Turner, Program Coordinator

title:
Food Service

80076(a) Food Services
(19) All equipment, fixed or mobile, dishes, and utensils shall be kept clean and maintained in safe condition.
(21) The kitchen has pots/pans/skillets that are burnt/rusted/non-stick coating peeling.
(22) Tableware and tables, dishes, and utensils shall be provided in the quantity necessary to serve the clients.

This requirement is not met as evidenced by

title:
Fixtures, Furniture, Equipment and Supplies

80088 Furniture, Fixtures, Equipment, and Supplies
(e)(3)All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition.  Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items.
(c)(2) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; and bath towels, hand towels and wash cloths.
This requirement is not met as evidenced by


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Avelina Martinez made an unannounced Annual inspection on 10/310/24 at 10:30am.LPAs observed there were no children in the facility and one staff onsite. During the inspection LPAs reviewed four staff files and inspected the facility. Facility citation violation of California Code of Regulation Title 22, Division 6, Chapter 1, Article 06. Regulations 80075(k) Health Related Services ,80075(l) Health Related Services, 80023(d)(2) Disaster and Mass Casualty Plan, 80066(a) Personnel Records, 84066(b)(6) Personnel Records, 80065(g)(1) Personnel Requirements, 84065(b)(1) Personnel Requirements and Health and Safety Code HSC1565(c) Exit interview conducted and a copy of this report and appeal rights left with Sherranda Turner, Program Coordinator.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility
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


summary: Facility Evaluation - 5 deficiencies

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Avelina Martinez made an unannounced Annual inspection on 10/15/24 at 2pm During the inspection LPAs observed one staff and no children were present in the facility. LPAs met with Sherranda Turner, Program Coordinator, Eliana Montes Administration Compliance Manager who assisted with the inspection. LPAs conducted a walk-through of the facility. LPAs observed the facility is a single story home with #4 bedrooms, #2 bathrooms LPAs inspected and/or reviewed the following: Staffing/Volunteers Number of Staff files reviewed _four Certified Administrators certificate valid and current__Administrator Certificate is missing_ Facility cited violation of California Code of Regulations, Title 22, Division Six, Regulations 84063(a) Accountability; 80065(f), 84065(d), 84065(i), 84065(j)(1) and 84065(k) Personnel Requirements; and 84075.1(a)(3) Emergency Medical Assistance, Injections, Self-Administration of Medications Exit interview conducted and a copy of this report and a copy of the appeal rights were left with Sherranda Turner, Program Coordinator.

Deficiencies:
84063(a): Accountability

(a) The board of directors shall be active in ensuring accountability, and shall perform, at a minimum, the following duties
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present
84065(i): Personnel Requirements

(i) Notwithstanding Sections 80065(f)(1) through (6), new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training as specified in (1) and (2) below
80065(f): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above for staff S1, S2, S3 and S4 are missing documentation of being trained in nutrition, housekeeping and sanitation, signs of illness, and community services and resources.
84065(k): Deficient Practice Statement
1
2
3
4Based upon review of the facility's Operations Policies dated 5/15/12 the facility is missing a plan to develop, maintain and implement a written plan for the training of facility managers which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
1
2
3
4

title:
Personnel Requirements

(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance.

This requirement is not met as evidenced by

title:
Personnel Requirements

(k) The licensee shall develop, maintain and implement a written plan for the training of facility managers.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On 10/30/ Licensing Program Manager (LPM) Dara Campos, Licensing Program Analysts (LPAs) Jean Stidman and Angelique Hill met with Krista Fiser, CEO, Eliana Montes Administration Compliance Manager, Isabel Rios, Director of Administration, Stephanie Player, Director of Programs, Sherranda Turner, Program Coordinator- Administrator and Acting Regional Manager Jodean Hall participated virtually in an office meeting for the purpose of a Non-Compliance Conference (NCC). No Board Members were in attendance. Previous citations were reviewed and a compliance plan was created. The following NCC primary areas of concern were reviewed: criminal record clearance, board accountability, personnel requirements, personnel records, health related services, reporting requirements, buildings and grounds, emergency disaster staff training and drills, food services, and furniture, fixtures equipment and supplies. During the NCC the facility was informed that if the facility does not come into substantial compliance it could lead to the revocation of the facility license and possible individual administrative action. The Department requests the facility submit a revision of the facility's Plan of Operation/Program Statement (POO/PS) to align with current regulations and/or expectations as stated in the LIC9106 which includes a staff training program, documentation of internal controls to address the oversight of assistance of self-administration of medication and documentation, audit of staff files and staff training, pictures and/or documentation the buildings and grounds meet Title 22 regulations by 12/31/24. The Department requests the facility submit a long-term plan to ensure the facility has a qualified administrator by 03/30/25, required documentation to the Department related to Annual Inspection visits on 10/01/2024 and 10/15/2024, and Case Management visits on 10/01/2024 and 10/15/2024 for citation(s) with POC due dates of 11/01/2024 and 11/15/2024 by 11/01/2024 and 11/15/2024 respectively. Continued on the LIC809C The Department will provide the two board members with the Facts You Need to Know Booklet and the LIC9165 which are to be returned by 11/30/2024. If they are not returned the facility is to follow up with the board members and to ensure they are signed and returned by 11/30/2024. Based on record reviews, the facility will be on the NCC for twelve months and increased oversight will remain in effect through 10/30/25. A copy of this report was provided via email to Krista Fiser CEO for signature.

met_with: Krista Fiser, CEO


summary: Facility Evaluation

raw_content:
Narrative:
On 4/8/ Licensing Program Analyst (LPA) Jean Stidman met with Connie Cueva, Director of Programs for the purpose of a case management regarding two separate incidents that occurred on 3/30/25. The reports submitted involved contact with Law Enforcement (LE).The facility submitted the LIC Unusual Incident/Injury Report form as well as the LIC LE Law Enforcement Contact Report. LPA stated the LIC624 form is not needed when the LIC LE report has been submitted. LPA reviewed the details of both incidents with Connie Cueva and observed the details for both incidents are different on the LIC624 and the LIC LE. LPA stated the information reported needs to be accurate. The facility will resubmit the reports.

met_with: Connie Cueva Director of Programs


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 4/8/25 at 11:30am. During the inspection LPA met with Connie Cueva, Director of Programs, who assisted with the inspection. LPA conducted a walk-through of the facility. There were two children and one staff present during the inspection. One additional staff present arrived during the inspection. Number of staff interviewed two Number of clients interviewed two. LPA observed the facility has four bedrooms, and two bathrooms LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X_ Refrigerator Temperature at or below 45 degrees F 38 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X_ Menu present and posted__X__ Working telephone __X_ First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) _X_ Medication centrally stored, locked/inaccessible _X_ Fire Extinguishers inspected Oct 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks_x Soap and Paper towels __X_ Laundry Facilities(available) __X__ Facility free of vermin _X__ Bedroom required bedding/furniture in good repair) __X___ Client Records Number of Clients files reviewed four Centrally Stored Medication and log reviewed for one child receiving medication. LPA received an updated LIC500. An exit interview was conducted and a copy of this report was left with Connie Cueva Director of Programs No violations were cited.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 4/17/25 at 10:30am. LPA met with Sherranda Turner, Administrator who assisted with the inspection. LPA conducted a walk-through of the facility. There were no children and one staff present when LPA arrived and two additional staff and one child arrived during the inspection. LPA inspected and/or reviewed the following: Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_125 degrees in both bathrooms and 128 degrees in the kitchen. The facility has prominent warning signs visible.__X_ Carbon monoxide detectors __X_Smoke Detector __X___ Bedrooms-required linen and furnishings Operations Complaint Procedures For Youth Posted _X__ Board Minutes Reviewed __X__ Disaster Preparedness Disaster and mass casualty plan updated and available __X__ Quarterly Drills conducted and documented__x__ Disaster preparedness supplies verified __X___ The following items were reviewed for compliance: Annual fees and LIC610C. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80070(b)(6) Client Records. LPA provided a copy of this report to Sherranda Turner, Administrator, on this date.

met_with: Sherranda Turner, Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 4/23/25 at 10:30am. LPA met with Sherranda Turner, Administrator who assisted with the inspection. LPA conducted a walk-through of the facility. There were no children and one staff present when LPA arrived and the administrator arrived during the inspection. One staff was interviewed. LPA inspected and/or reviewed the following: Physical Plant Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F 36 degrees Freezer Temperature at or below 0 degrees_4 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Menu present and posted__X__ LPA observed the cabinet below the kitchen sink appears to have water damage. LPA observed two bedrooms have graffiti on the walls and one bedroom has paint peeling on the window seal/ledge. LPA observed the washing machine has rust below the lid. Staffing/Volunteers Number of Staff files reviewed _eight Criminal record clearances verified eight Certified Administrators certificate valid and current__X_ Client Records Number of Clients files reviewed one and LPA observed the appraisal form is in the child's file. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation Buildings and Grounds. LPA provided a copy of this report to Sherranda Turner, Administrator on this date.

Deficiencies:
80087(a): 80087(a) Buildings and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 5/6/25 at 10:00am. LPA met with Sherranda Turner, Administrator who assisted with the inspection. LPA conducted a walk-through of the facility. There were no children, and one staff present when LPA arrived and two other staff arrived during the inspection. LPA inspected the facility and observed the graffiti on the walls in two bedrooms has been removed and the paint peeling in one bedroom has been repainted. LPA observed the cabinet below the sink that appeared to have water damage has been repaired and the washing machine that had rust below the lid was replaced with a new washing machine. LPA reviewed eight staff records and observed: staff files missing documentation for staff S2, S3, S4, S5, S7, and S9 of education. Facility cited violation of California Code of Regulations, Title 22, Division 6, regulation 80066(a)(6) Personnel Records. LPA provided a copy of this report to Sherranda Turner, Administrator on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 8/18/25 at 10:45am. LPA met with Connie Cueva, Director of Programs, who assisted with the inspection. LPA conducted a walk-through of the facility. There were no children, and one staff present when LPA arrived and one other staff arrived during the inspection. Number of staff interviewed two No clients were interviewed. LPA observed the facility has four bedrooms, and two bathrooms LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F 36 degrees Freezer Temperature at or below 0 degrees_-1 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Menu present and posted__X__ Working telephone__X_ Carbon monoxide detectors __X_Smoke Detector _X__ First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__108 degrees_ Fire Extinguishers inspected October 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X___ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Video Cameras were observed in the dining room, living room, kitchen and the front and rear porches.. The facility has signed notifications of the video cameras posted and in the child's file. Operations Complaint Procedures For Youth Posted _X__ Board Minutes Reviewed __X__ Disaster Preparedness Disaster and mass casualty plan updated and available __X__ Quarterly Drills conducted and documented__x__ Disaster preparedness supplies verified __X___ Staffing/Volunteers Number of Staff files reviewed _five Criminal record clearances verified _five_ First Aid Certificate__five__ Certified Administrators certificate valid and current__X_ Client Records Number of Clients files reviewed one Centrally Stored Medication and log reviewed one Medication and log reviewed _one_Cash Resources__one__ No violations were cited. An exit interview was conducted and a copy of this report was left with Connie Cueva Director of Programs.

met_with: Connie Cueva, Director of Programs


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 12/2/25 at 10:15am. LPA met with Connie Cueva, Director of Programs, who assisted with the inspection. LPA conducted a walk-through of the facility. There was one child and staff present when LPA arrived and one other staff arrived during the inspection. Number of staff interviewed two Number of clients interviewed one. LPA observed the facility has four bedrooms, and two bathrooms LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F 40 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Menu present and posted__X__ Working telephone__X_ Carbon monoxide detectors __X_Smoke Detector _X__ First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__118.5 degrees_ Fire Extinguishers inspected October 2025. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X___ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Video Cameras were observed in the dining room, living room, kitchen and the front and rear porches.. The facility has signed notifications of the video cameras posted and in the child's file. Operations Complaint Procedures For Youth Posted _X__ Board Minutes Reviewed __X__ Disaster Preparedness Disaster and mass casualty plan updated and available __X__ Quarterly Drills conducted and documented__x__ Disaster preparedness supplies verified __X___ Staffing/Volunteers Number of Staff files reviewed _five Criminal record clearances verified _five_ First Aid Certificate__five__ Certified Administrators certificate valid and current__X_ Client Records Number of Clients files reviewed two No medication logs reviewed due to no children are currently taking medication Cash Resources_two_ No violations were cited. An exit interview was conducted and a copy of this report was left with Connie Cueva Director of Programs.

met_with: Connie Cueva, Director Programs


summary: Facility Evaluation

raw_content:
Narrative:
On 4/8/ Licensing Program Analysts (LPAs) Jean Stidman and Angelique Hiil met with Chelsi Gapasin Youth Services Program Manager, for the purpose of a case management inspection. During an investigation, it was discovered the facility did not abide by its program statement. LPA Sidman reviewed one discharge form for one client which states the client's intake date was 11/7/23 and the client was discharged from the facility on 1/7/24, which is 61 days. A review of a printout of clients in the facility from 10/12/23-12/19/23 shows another client was enrolled on 9/26/23 and was discharged on date 10/19/23. The facility program description states services are provided to the clients for "up to 21 days". The facility is cited violation of California Code of Regulations Title 22, Division 6, regulation 84022(b)(2) Plan of Operation. A copy of this report was reviewed and left with Chelsi Gapasin Youth Services Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Avelina Martinez made an unannounced inspection on 10/01/24 at 9:30am for the purpose of a case management. The facility did not report eight incidents according to Title 22, Division 6, Chapter 1, Article 06. 80061(b) Reporting Requirements. On 6/14/24 the facility submitted three incident reports by email for incidents that occurred on 6/11/24. These reports should have been submitted to Community Care Licensing Division (CCLD) by 6/12/24. On 6/22/24 the facility submitted one incident report dated 6/17/24 should have been submitted to Community Care Licensing Division (CCLD) by 6/18/24. On 7/1/24 the facility submitted one incident report dated 6/25/24 should have been submitted to CCLD by 6/26/24. On 8/22/24 the facility submitted one incident report dated 8/19/24 should have been submitted to CCLD by 8/23/24. On 8/30/24 the facility submitted one incident report dated 8/28/24 should have been submitted to CCLD by 8/29/24. On 9/5/24 the facility submitted one incident report dated 9/3/24 should have been submitted to CCLD by 9/4/24. Facility citation violation of California Code of Regulation Title 22, Division 6, Chapter 1, Article 06. 80061(b) Reporting Requirements. Exit interview conducted and a copy of this report and appeal rights left with Sherranda Turner, Program Coordinator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Avelina Martinez made an unannounced inspection on 10/15/24 at 10:00am for the purpose of a case management regarding on incident that occurred on 10/7/24. LPAs observed there were no clients present during the inspection and one staff was onsite. The facility reported there was a medication error. Based upon record review the facility did not document the time of each dose taken by the child for ten different medications and three different medications are missing staff initials when the medication count sheet documented the medication was given. Facility cited violation of California Code of Regulations, Title 22, Division Six, Regulation 80075(b) Health Related Services on the attached LIC809D." Exit interview conducted and a copy of this report and a copy of the appeal rights were left with Sherranda Turner, Program Coordinator.


facility_name: SAILS CRISIS

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Group Home staff denied the alleged allegations and further indicated that each staff member that provided one on one care was responsible of maintaining C1's bedroom daily; due to C1's medical condition which required staff to be diligent in maintaining a clean environment. Relating to allegation involving client not receiving a proper balance diet, C1 was being properly cared for by staff and was provide three meals a day containing the five food groups. Staff indicated that on some occasions C1 would refuse the food that was being provided and would throw a tantrum until C1 received what C1 wanted which at times would consist of cereal for dinner or other snacks as a meal. Information obtained from CSW did not corroborate the alleged allegations and further indicated that there are no immediate concerns to the health and safety of the clients however did indicated that staff should continuously receive training when caring for this type of population. Therefore, based on the information received, the above allegation is determined to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Group Home Administrator. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of the report along with the (LIC 811) was sent via email to the GH Administrator.

Investigation Findings:
13On May 12, 2021, at 10:19 a.m., Licensing Program Analyst (LPA) Winston Moroney, conducted a teleconference inspection to the above Group Home (GH) and met with GH Administrator Mauricio Villatoro. The purpose of the teleconference was to deliver the findings for the above complaint allegations. On November 24, 2020 the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff fail to properly maintain minors room while in care and Staff fail to ensure minor is properly fed while in care. The investigation to the above allegations was conducted by this LPA and it consisted of, but not limited to a review of records, including the children needs and services plans, medical records and interviews with 4 staff S1 on 4/6/2021, S2, S3 on 5/7/21, S4 on 5/4/21, CP and CSW on 12/2/2020. No statements were obtained from C1 and C2 due to being non-verbal. (Reference Confidential Names Form LIC 811, dated May 12, 2021). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: SAILS CRISISFACILITY NUMBER: VISIT DATE: 05/12/2021

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

met_with: Mauricio Villatoro - Administrator