337900079-12-3-2023-19-CR-DALZ-CY6NNY-20231203093729

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 337900079
Report Date: 11/09/2023
Date Signed: 12/03/2023 09:38:02 AM

Document Has Been Signed on 12/03/2023 09:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME:	HARMONY HAVEN CHILDREN AND YOUTH CENTER		FACILITY NUMBER:	337900079
ADMINISTRATOR:	HEIDI LOMBARDI		FACILITY TYPE:	722
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	48	CENSUS:	DATE:	11/09/2023
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Heidi Lombardi		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On November 09, 2023, Community Care Licensing met with several Riverside County agencies, via Microsoft Teams, to discuss the review of the Riverside County Transitional Shelter Plan of Operations and Program Statement edits and revisions submitted to Community Care Licensing on April 26, 2022. Children's Residential Program Regional Manager, LaCresha Cook, Licensing Program Manager, Natasha Dunlap, Licensing Program Analyst (LPA) Darlene Oseguera, Systems of Care Analyst, Gina Jones, Provider Policy Implementation Unit Manager, Alicia Bernstein, met with Deputy Director, Allison Donahoe, Administrator, Heidi Lombardi, Administrator Analyst Jenell Ross and Administrative Service Manager, Nicole Ford. During the meeting the following was discussed: revisions to Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports and possible name change. The opportunity for questions about the revisions was provided to facility representatives with a summarized review of revisions. The revised plan of operation and program statement, and any application and supportive documentation will be due on November 27, 2023 (per facility request). The following is a summary of the review of the revisions to the Plan of Operation/ Program Statement completed by LPA Darlene Almaraz-Oseguera, Systems of Care (SOC) Policy Analyst Gina Jones,Family Intake and Engagement Unit, Adele Carlson and California Foster Care Ombudsperson, Larry Fluharty. CCL Review: Pink SOC Review: Green Family Intake and Engagement Unit Orange: Foster Care Ombudsman: Blue Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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Part I Program Identification

Part II Program Population, Services and Capabilities

Part III Program Narrative

A. PROGRAM DESCRIPTION

Sec 3. PROGRAM DESCRIPTION, PURPOSE, METHODS GOALS

In this section you mention several times that you are designed to provide care and therapeutic services up to 90 days from date of admission and site the Health & Safety code 1502.3. We recommend instead that you be consistent throughout with the use of the wording in the Operating Standards for Transitional Shelter Care Facilities (TrSCFs), February 2023, section 86622 (l) Plan of operation which states “The plan of operation shall provide that no child may stay in the facility longer than 72 hours…”. As all counties are working with their local system of care to reduce reliance on shelters, 72 hours is the goal of Transitional Shelter Care facilities.

Pg 26. In this section, you briefly discuss services, please expand to include more about the type of therapeutic activities, counseling and services to families, transition services and wraparound, that are evidence based and trauma informed (Provide a summary of your services here as discussed in section 5 etc.). How will the facility support the differing needs of children and their families including LGBTQ+, those with developmental disabilities, CSEC youth, pregnant and parenting youth, those under six years of age, those needing STRTP level of care and those being removed from their home for the first time. The information provided needs more development.

Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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Sec 4. PLANNED ACTIVITIES/USE OF COMMUNITY RESOURCES

Pg 27 you discuss how the facility will partner with the case carrying social worker to provide access to community resources. List all the community resources available in your area. In section 4 Please explain what these agencies are and what are the services they will provide. For example, what kind of agency is Faith in Motion? the family resource center and what services will they and the community college provide? List them out. create more of a chart with types of service and contact information, and how will these resources be used to support the populations you are serving at your facility? What are your community resources for youth with developmental disabilities- name the regional center etc, LGBTQ+, Pregnant and parenting youth, CSEC, children under six and families etc.? The resource list should be more fully developed for your area.

WIC 16001.9 Please clarify extracurricular activities that include but are not limited to access to computer technology and the internet, consistent with the child’s age, maturity, developmental level, sexual orientation, and gender identity and expression. Visits and contact with siblings, family members, and relatives, social contacts with people outside ethe foster care system including teachers, coaches, religious or spiritual members, mentors and friends. Please clarify the activities suitable for under six.

Pg 28- activities that meet needs identified in the youth’s case plan. This should include not only case plan but individual program plan (for those youth receiving regional center services)

p. 37 Exclusion from Extracurricular Activities based on psychotropic meds. FYR violation and discrimination based on a disability.

Sec 5. PERSONAL SERVICES/PROGRAMS OFFERED

Disaster response 86623
Do mention relocation sites and safe temporary accommodations for clients, please provide more information about where are the relocation sites?

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 3 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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86623© please explain how the licensee shall instruct all clients, age and abilities permitting, in their duties and responsibilities under the disaster response plan.

In your runaway response section you provide the ratio of staff to children so could label this information so its easier to find or also add it to your program description section. Please include as stated in 86665.5 © that if the children require special care and supervision because of age, behavior or other factors, the number of on duty child care staff shall be increased.

What culturally relevant trauma informed services will youth have access to and how the facility will be culturally responsive? Please provide more information on What kind of cultural and religious groups will you connect youth to? For example you say individual and group activities “are culturally responsive” or “support culture, ethnicity and identities of the youth” , Please explain how. For example how will you ensure your facility is accepting of all youth? LGBTQ+, different race and ethnicities, those with disabilities etc. H& S Code 1522.45; 86678.2 how will you ensure fair and equal access to all services, placement, care and treatment and benefits.

How will facility ensure after assessments, services are received timely? Including to a mental health provider? Please ensure what’s discussed in section 5 regarding screenings and assessments aligns with section 6. Pg 31 under intervention and practices “screening and assessment”, the third sentence says “ after assessment, “ within one week, referrals are made to mental health providers when necessary.” Please clarify, given this is a three-day facility, please provide a more expedited time frame to meet the needs of the child while at the facility. Per 86668.1 screenings to identify the child’s mental and medical needs shall happen within 24 hours. How will you meet the needs of the child as identified through screening and assessments with reasonable promptness and enable timely transitions from the facility. WIC 16001.9.
Please note this time frame for mental health screenings is different in section 6 where you say 24 hours.
Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 4 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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Sec 6 MEDICAL/DENTAL

Please clarify how screening and assessments are used. Are screenings used to initially identify needs that may trigger a more thorough assessment? What is the criteria for a more thorough assessment? Given the differing level of needs, why would all youth need an assessment? How will you ensure screening and assessments are trauma informed?
☐How are the screening and assessment procedures modified to meet the needs of youth with special health care needs? 86610.1- don’t see
☐How will you ensure screening and assessments are trauma informed? - don’t see this

Please explain how the facility will ensure the health and safety of children during their entire stay at the facility, including a plan to ensure appropriate levels of care and supervision is provided as determined by the screenings and assessments OS 86622

☐If separation from others is required how will the separation room be used in a trauma informed way for medical or mental health purposes? What will a separation room not be used for? 86675 (c)

Page 33 2^nd to the last paragraph:
In above section it states that staff will evaluate if they can go on outing recreational outing based on if they are refusing psychotropic medications. This statement seems to be a contradiction.

p. 44 Medication storage: appears to conflict with CCL guidance for youth who can administer their own medication

Sec 7 TRANSPORTATION

You state “communication is is maintained with the region “Please explain what you mean by “the region”
You state that “while youth are staying at the facility staff will ensure there isn’t a lapse in care services. “ and “the decision for staff to transport a youth is dependent on both the availability of a vehicle and if staff are available, otherwise, the social worker is responsible for transporting the youth.” In those situations where the social worker is responsible for transporting the youth how will the facility ensure this happens so there isn’t a lapse in care services? Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 5 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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A. ADMISSION/ASSESSMENT/DISCHARGE POLICIES AND PROCEDURES
Sec 8. ADMISSION/INTAKE

Pg 37 in the section titled “Prior to youth arrival” what does 7) mean WC does not utilize an admission form. This statement is confusing is this different than an admission agreement? consider deleting unless you think its necessary and explain what an admission form is.

OS section 86668.1 says medical and mental health screening shall be performed by a licensed physician or designee, who is also a licensed professional. You state that social service supervisors I/II are not licensed professionals. Please explain how social service supervisors I/II will meet the OS requirements?

If a screening indicates a more thorough assessment is needed. What’s the time frame from screening and assessments to services? 86668.1 (a)(3) states that ongoing supportive services identified during the pre-admission screenings shall be provided as needed by the child during their placement in the facility.

At intake you mention creating a child’s file. How will you ensure all screening and assessments, including QI assessments and services needed and provided at the shelter, will be documented in the child’s file? How will you ensure that information is entered timely, accurately and is complete in the child’s file?

Pg 39 please spell out acronym IRC

Does the intake and admission process include a child’s advance directive regarding early triggers, de-escalation, or the use and non-use of seclusion or behavioral restraints- don’t see this

What information shall the facility request and use to determine the compatibility for the shelter placement for that individual youth and determining commonality of need?
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Please explain commonality of need considerations for youth assessed as requiring STRTP level care. How will you ensure the safety of all children with differing level of needs? – don’t see this

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SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 6 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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what are the timeframe for responding to referring agencies regarding acceptance or rejection of referral - dont see this

Please explain how the “weekly think together Thursday meetings”, are described more -in your reporting requirements and continuous quality control section. and briefly describe here how these meetings will support the county placing agencys efforts to secure an immediate STRTP placement for a child assessed as meeting the applicable criteria for placement in an STRTP. Will there be a list of STRTPs that the county will have a relationship with for example?

Sec 9. CLIENT PLANS (NEEDS AND SERVICES PLANS) /ASSESSMENTS
Although you are not using a needs and services plan, how will the case plan be used and updated? Will this also be kept in the client folder?

How will the facility ensure screening and assessments are documented?

How will the facility ensure services provided meet the treatment needs of the child as assessed?

How will the facility ensure consistency with the case plan/TILP as developed by the county placing agency and recommendations by the child and family team.

Please explain Care plans for children that meet criteria for STRTP placement

Please explain how the licensee will consider the child’s medical and mental health screening and assessments and observe and evaluate the behaviors and social interaction and other important characteristics for the purpose of informing the child case worker about the child to facilitate appropriate and timely placement into an approved or licensed home or facility 86668.2

Sec 10. DISCHARGE/REMOVAL

You added information about working with the county with the transition plan and discharge. Please explain how this plan also involves the child’s local team and local system collaboration including with regional center, school, mental and behavioral health, and family to identify appropriate placement, transition, and aftercare services. 86668.4(a)(1)

Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 7 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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When discussing the technical assistance calls, are you speaking of State level technical assistance calls? Please clarify contact information for State level TA calls as discussed on this website. Child-Specific Technical Assistance Calls Website – This website provides information on types of TA calls, resources for reducing barriers to placement for complex care youth, and funding. If these are the TA calls you are referring to, please add the provider or shelter staff familiar with the youth, will be on the call when needed (not just the case carrying social worker)

Sec 11. VISITATION RULES AND POLICY

Will the child have a prior meeting with the new placement or visit before being transferred? You state that the youth may ask that they meet the family/ facility first before being placed with them, please explain will you discuss this with the youth? And will it be discussed upon admission or when?

Sec 12. HOUSE RULES/ PERSONAL RIGHTS

Completing homework - will there be assistance with homework?

What is your e stablished procedures to periodically check-in with children to remind them of their personal rights?

p. 55 rules Touch only Siblings (this may violate FY rights, it would be difficult to enforce and clinically backwards), getting dressed changing only in bathroom or shower

A. GENERAL POLICIES AFFECTING CHILDREN PLACED

Sec 13. DISCIPLINE POLICIES
The plan of operation discusses how children, and authorized representatives shall receive copies of discipline policies and procedures. Please explain how Signed copies of the discipline policies and procedures are maintained in child’s files. Health and Safety Codes (HSC) Section 1501, 1531,- don’t see this

Page 44 when discussing physical control techniques, and that the WC staff will be trained in CPI, nonviolent crisis intervention…Please spell out the acronym CPI – is this evidence based? Please provide citation.

Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 8 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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Please provide a description of how trauma-informed practices are embedded in the provider’s discipline procedures, as well as how discipline policies account for the nature of youths’ trauma (including specialized populations). Health and safety Code, Section 1522.45

Please clarify that calling or threatening to call law enforcement is prohibited as a form of discipline 86672.1

Sec 14. EMERGENCY INTERVENTION PLAN

Pg 42. Although you have begun to develop your EIP and have provided a list of early interventions and expected outcomes, and have stated you are not using manual restraints, Please explain the process more for having the Special investigations unit and peace officers to assist in your emergency intervention plan. Wouldn’t they be considered part of your staff since they are working in your facility and with your clients and included on the lic 500? How will you provide oversight of this staff and ensure they are available at all times that youth are in care? How quickly can they respond from an offsite trailer? Please explain how their manual restraint training and plan meet the OS requirements. Is this verbal Judo: the gentle art of persuasion and post certification” model approved by a behavioral specialist? You mention an LCSW only. How does the model follow the requirements of the OS section 86700, 86700.1, 86722, 86722.1.? note: In addition to techniques specified in Section 86700.1(a), how will you ensure that any emergency intervention technique not approved for use as part of the licensee's emergency intervention plan are not used at any time?

86700.1 (e ) please clarify Law enforcement must not be contacted as a substitute for effective care and supervision or the facility’s approved continuum of emergency interventions.

Please explain more about when you would involve law enforcement or not and how it will be used as a“last resort.” 86722 (e )(B).

Please add names of facility personnel including security personnel trained to use emergency interventions. (86722)(d)(1).

Please ensure you have the following in your manual restraint plan regarding timelines during the use of restraints with a child. Please see OS 87622 (f)(1)-(2)

Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 9 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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Pg 44. You mention that the special investigations unit is onsite in a trailer as peace officers and will assist with physical control techniques as necessary. And you list what restraints or interventions will never be used by WC staff, what restraints and interventions will never be used by the peace officers or are they considered WC Staff,?

If the peace officers will be called, how do you ensure that manual restraints will not be used when youth have a medical condition that would contraindicate the use of manual restraints or when the child’s current condition contraindicates the use of manual restraints.
Pg 45- please clarify the community resources listed and how they will assist.

Pg 46 When you say ongoing training is required for all WC staff in this section, please clarify what kind of training you are referring to.

On page 46 you state that where a youth is presenting imminent risk of danger to themselves or others, a lead staff will immediately decide to remove the youth from the situation by regrouping or use intervention techniques, please explain how you will remove the youth if they don’t want to go? You state WC staff do not use physical restraints. What do you mean you will move youth to a neutral location? If there is no separation room, Where will they go? Please explain.

What are the documentation and reporting requirements you will implement with crisis intervention plan, and maintained in the child’s record as required in 86761? Including a log of interventions. Please clarify how you will document those interventions used by the peace officer staff in your facility.

Procedures for using emergency interventions if more than one child requires the use of emergency intervention at the same time 86722(d)(6).

Per OS 87622(d)(6)-(10), please include procedures for:
ensuring care and supervision is maintained in the facility when all available facility personnel are required for the use of emergency interventions.
Please clarify what are the procedures for reintegrating the child back into the facility routine after an emergency intervention technique?
Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 10 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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Please clarify if your emergency intervention plan is designed and approved in conjunction with the licensee, by an individual with the qualifications of a behavior management consultant as defined in section 86601(b)(3)- and does the licensed clinical social worker you mention meet the qualifications of a behavior management consultant?
Please provide criteria for assessing when:
an emergency intervention plan needs to be modified or terminated. 87622 (d)(9)
and / the facility does not have adequate resources to meet the needs of a specific child 87622(d)10)

Please use the language that the written emergency intervention plan will be submitted to and approved by the Department prior to implementation. The plan must include the requirements specified in Sections 86722(d) through (h).

Sec 15. RUNAWAY PLAN
How is the runaway plan provided and discussed with each child and their authorized representative at the time of admission and maintained in the child’s record?

Sec 16. CHILDREN’S COMPLAINT/GRIEVANCE PROCEDURES

p. 66 Seem to be conflating CCL and Ombudsperson’s office. Need to specify that these are separate and youth can complain to both confidentially and without fear of retaliation.

Sec 17. HANDLING YOUTH FUNDS
Please include language regarding the following Per OS 86626(h)(1) accounting requirements, including (k) handling money with death of a client and (m) gifts.

p. 68 Allowance. What is the plan if youth says longer than 3 days. This will happen. Need a plan for allowance if a youth is there more than a week. Ideally, youth should receive allowance for a week regardless of length of stay so that allowance is not an incentive to remain at the WC.

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SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 11 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

NARRATIVE

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A. STAFFING/ADMINISTRATIVE ORGANIZATION
Sec 21. STAFF SCHEDULE (LIC 500)

Sec 22. STAFF QUALIFICATIONS
Please use the operating standards to develop this section and provide information on

☒Qualified mental retardation professional 86665(t) monthly consultation if one youth with diagnosis is at facility- DON’T SEE
Don’t see clearly the qualification requirements for an administrator (AKA regional manager) in the text. Please ensure that the administrator qualifications and duties adhere to OS Section 86664 (g)

Don’t see clearly the qualification requirements for a manager and what the title you use for manager. Please ensure that the facility manager meets the following requirements:
OS 86665(q)

we need to see they meet minimum education and experience requirements in the OS. Os Missing duty statement for social supervisor I. The temporary community services support representative is not found on the lic 500 nor the activity planner. Please indicate who is the manager on the lic 500 and duty statement as well as in the body of the text.

Os 86669(a) requires a licensed physician or designee who is also a licensed professional to do screenings please clarify at intake and client medical assessment section as well as on the duty statements. Who does the assessments?. are they a licensed professional?

Sec 23. JOB DESCRIPTIONS
Sec 24. INSERVICE TRAINING FOR STAFF/ADMINISTRATOR
Please explain the process for emergency intervention training orientation for new staff and ongoing training 86722- please clarify what is required for orientation vs annual training.
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SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 12 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

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Please list all minimum training topics required in the OS 8665 Personnel requirements including (f) (1)-(6) and (v) (3) (A)-(X).

Please describe how staff training will Be designed to ensure: 1. Cultural competency and sensitivity; including but not limited to best practices for providing adequate care, services, and supports for children across diverse ethnic and racial background, as well as children identifying as lesbian, gay, bisexual, transgender, or nonbinary. – don’t see
☐ Please describe your training on methods to behaviorally support children as appropriate for children impacted by trauma or child abuse and neglect; and- don’t see
☐ please describe how your training includes best practices for addressing the permanence, well-being, and educational needs of children, including children with disabilities.- don’t see

In section 86665 The OS state the annual training plan shall include for each subject please provide the following: - don’t see
Title, subject matter
Learning objectives and activities
Number of hours per training
Qualifications of trainer
Training evaluation
p. 77 Why is youth rights ½ hour but RPPS is 2 hours? This is out of balance. OFCO rights trainings are typically 2 hours or more to cover FYBOR and RPPS.

Sec 26. VOLUNTEERS- N/A
Sec 27. CONTROL OF REAL PROPTERTY
Sec 28. FACILITY SKETCH (LIC 999)
Sec 25. ADMINISTRATION- cant read organizational chart
Sec 29. BOARD OF DIRECTORS STATEMENT

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SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

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ADDITIONAL NOTES:

Reporting Requirements and Continuous Quality Control- ok

The System of Care and Reducing Reliance on Shelters

Please create a summary timeline of how things occur at the facility from the first to last day of placement for the following areas: intake; screening and assessment; health, mental health, behavioral health, or other services as needed, CFT meeting, placement finding, and placement/discharge, reporting requirements. – see the timeline can you indicate what is planned on day 1-3?

Please indicate how you will work with your local team to coordinate services in the timeline including schools, regional centers, BCBA and mental health providers and families. – Don’t see

p. 28 Exclusion from Extracurricular Activities based on psychotropic meds. FYR violation and discrimination based on a disability.

p. 34 Medication storage: appears to conflict with CCL guidance for youth who can administer their own medication

p. 41 rules Touch only Siblings (this may violate FY rights, it would be difficult to enforce and clinically backwards), getting dressed changing only in bathroom or shower

p. 47 Seem to be conflating CCL and Ombudsperson’s office. Need to specify that these are separate and youth can complain to both confidentially and without fear of retaliation.

p. 48 Allowance. What is the plan if youth says longer than 3 days. This will happen. Need a plan for allowance if a youth is there more than a week. Ideally, youth should receive allowance for a week regardless of length of stay so that allowance is not an incentive to remain at the WC.

p. 52 Why is youth rights ½ hour but RPPS is 2 hours? This is out of balance. OFCO rights trainings are typically 2 hours or more to cover FYBOR and RPPS.

Continued on next page

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

Page: 14 of 15

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501

FACILITY NAME: HARMONY HAVEN CHILDREN AND YOUTH CENTER	FACILITY NUMBER: 337900079
	VISIT DATE: 11/09/2023

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In addition to the above information it was also discussed clarification of the fire clearance. The facility was advised by Regional Manager (RM) LaCresha Cook that CCL needed to know if the fire clearance was going to be for one or the four individual buildings/addresses. RM Cook also advised that if there were any staff fingerprints/clearances that were delayed 30 or more days or if the facility was having any issues with Guardian to please follow up with LPA or LPM to get those clearances expedited. The facility was also advised by RM Cook that if the clients were going to be placed at the facility longer than the 72 hours, that the facility needed to submit documentation with regard to a request to operate outside of the latest Operating Standards for Transitional Shelter Care facilities. It was also discussed clarification regarding a recommendation provided by Office of Foster Care Ombudsman (OFCO) in regard to client allowances. Licensing Program Manager (LPM) Natasha Dunlap explained that CCL will follow up with OFCO and provide an update once received.

A copy of this report was emailed to Heidi Lombardi, for signature.

SUPERVISOR'S NAME: Natasha Dunlap	TELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Darlene Almaraz	TELEPHONE: 951-205-1658
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

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