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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336427799
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:53:35 PM

Document Has Been Signed on 09/22/2021 03:53 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, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME:HARVEST SAFE HAVEN FOR BOYSFACILITY NUMBER:
336427799
ADMINISTRATOR:LACHELLE FENISONFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: DATE:
09/22/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lachelle FenisonTIME COMPLETED:
03:55 PM
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An informal conference was held with Harvest Safe Haven For Boys to discuss current Community Care Licensing (CCL) concerns. Present at the meeting was LaCresha Cook, Regional Manager, Abdoulaye Traore, Licensing Program Manager, Adaleyci Caballero, Licensing Program Analyst, Shanae Pharaoh, Licensing Program Analyst, Lachelle Fenison, Harvest Safe Haven For Boys Administrator, Daniel Park, Harvest Safe Haven For Boys Chief Executive Officer, Susan Pennington, Harvest Safe Haven For Boys Licensed Clinical Social Worker Supervisor, Jason Brunt, Harvest Safe Haven For Boys Board President, Diana Wagner, System of Care Branch, Janelle Ross, Riverside County Placement Liaison, Karen Atkins, Riverside County, David Guitierez, Sandi Snelgrove, Alexandria, Andrews, Department of Health Care Services, Juan Bretado, Riverside County Probation, and Rose Collins, San Bernardino County Placement Liaison.

The following information was discussed:
  • SIR's are required to have additional information to indicate precursor to incidents, interventions used according to EIP, and staff follow up.
  • Level system needs to be trauma informed.
  • AWOL policy needs to be trauma informed.
  • EIP needs to be more trauma informed.
  • Program must ensure staff understand the EIP.
  • Update to Program Statement.

The facility has agreed to the following:
  • The Clinical Supervisor will review all incident reports before submitting to CCL to ensure clinical interventions, follow-up, and debriefing summary are included.
  • Program Statement will include updated incentive system addendum.
SUPERVISORS NAME: Abdoulaye Traore
LICENSING EVALUATOR NAME: Adaleyci Caballero
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME: HARVEST SAFE HAVEN FOR BOYS
FACILITY NUMBER: 336427799
VISIT DATE: 09/22/2021
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  • Facility has implemented training and coaching for staff with the Rehab Specialist.
  • Facility will update their Program Statement to address areas mentioned above.
  • Facility will update their Program Statement to include the Risking Connection Model and additional treatment for creating a trauma informed milieu.
  • Facility will ensure staff are receiving training on implementing three trauma informed interventions for all incidents occurring at the facility.
  • Facility will submit their corrective action plan including their addendum to their Program Statement by October 1, 2021.


A copy of this report was given and explained to Lachelle Fenison.
SUPERVISORS NAME: Abdoulaye Traore
LICENSING EVALUATOR NAME: Adaleyci Caballero
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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