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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198206911
Report Date: 10/11/2022
Date Signed: 10/11/2022 12:22:22 PM


Document Has Been Signed on 10/11/2022 12:22 PM - 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, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245



FACILITY NAME:ADOLESCENT GROWTH, INC.FACILITY NUMBER:
198206911
ADMINISTRATOR:LEWIS, JOILYNFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 5DATE:
10/11/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator - Joilyn Lewis and COO - John LewisTIME COMPLETED:
12:23 PM
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On October 11, 2022 at 10:00 AM, a Non-Compliance Meeting was conducted at the El Segundo Regional Office to discuss compliance issues with Adolescent Growth, Inc.

Present at the Non-Compliance Meeting were the following individuals:
1. Joilyn Lewis, CEO/Administrator
2. John Lewis, COO
3. Kellee Coleman, Regional Manager
4. LaKescia Smith, Licensing Program Manager I
5. Stephen Kim, Staff Service Manager I
6. Charmetha White, Licensing Program Analyst
7. Connie Jones-Steward, Licensing Program Analyst
8. Zena Phillips, Licensing Program Analyst

The purpose of the meeting was to discuss the following:
1. Substantiated IB complaint dated 12/08/2021
2. Reporting requirements
3. LE Contact
4. Lack of Supervision
5. Staffing issues
Regional Manager, Kellee Coleman discussed with licensee the concerns related to the Substantiated IB Compliant.

Report continued on LIC 809C.
SUPERVISOR'S NAME: Lakescia SmithTELEPHONE: (424) 301-3025
LICENSING EVALUATOR NAME: Charmetha WhiteTELEPHONE: 424-301-3075
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245
FACILITY NAME: ADOLESCENT GROWTH, INC.
FACILITY NUMBER: 198206911
VISIT DATE: 10/11/2022
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Licensee informed Regional Manager the incident was not reported to the department because an internal investigation conducted by the Administrator revealed that the allegations were not true as the client retracted the allegation.

It was advised during the meeting that the Licensee will attend the Quarterly Provider meetings, train staff on reporting requirements, submit timely incident reports, and conduct three (3) month check ins with their assigned analyst for the next twelve (12) months to ensure the department is receiving incident reports.

Copies of the following regulations discussed and provided to the licensee during the meeting: H&S 1533; H&S 1538.7; 80044; 80061; 84065.2; 84078; 80078; 84061; 85078

Additionally, the following Provider Notices were discussed and provided to the licensee during the meeting: PIN 17-04-CRP; 17-11-CRP.

An exit interview was conducted with licensee, a copy of this report was given to the licensee at the end of the Office Meeting.
SUPERVISOR'S NAME: Lakescia SmithTELEPHONE: (424) 301-3025
LICENSING EVALUATOR NAME: Charmetha WhiteTELEPHONE: 424-301-3075
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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