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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507003353
Report Date: 06/10/2021
Date Signed: 06/10/2021 11:51:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ELITE FAMILY SYSTEMS, INC- SCOFFIELD HOMEFACILITY NUMBER:
507003353
ADMINISTRATOR:R PADILLA/ J SNEEDFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 5DATE:
06/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Bill SneedTIME COMPLETED:
12:00 PM
NARRATIVE
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Complaint Specialist C.K. Kinney(CS) conducted a Case Management Inspection to discuss information related to LIC 624-LE Law Enforcement Contact Report with Date of Incident May 19, 2021. Mr. Sneed responded to the COVID-19 Screening questions and CS was allowed entrance into the offices. Interview of staff revealed a violation of Interim Licensing Standards. this facility is being cited for violation of Short-term Therapeutic Residential Treatment Program Interim Licensing Standards version 3.1 Article 6 Section 87072(d)(11) Personal rights.

Copy of this report and LIC 9058 Appeal Rights left at Elite Family Systems at conclusion of inspection.
SUPERVISOR'S NAME: Melanie KrageTELEPHONE: (559) 650-7905
LICENSING EVALUATOR NAME: Charles KinneyTELEPHONE: (559) 974-1171
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ELITE FAMILY SYSTEMS, INC- SCOFFIELD HOME
FACILITY NUMBER: 507003353
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/11/2021
Section Cited

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Personal Rights. The licensee shall ensure that each child, ..., is accorded the personal rights ...To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions...withholding of shelter, clothing, or aids to physical functioning.
This requirement was not met as evidenced by:
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Review of Law Enforcement Contact Report and Interview of staff revealed client's shoes were confiscated as an attempt to prevent client from leaving the house. This presents an immediate threat to the health, safety or welfare of clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melanie KrageTELEPHONE: (559) 650-7905
LICENSING EVALUATOR NAME: Charles KinneyTELEPHONE: (559) 974-1171
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2021
LIC809 (FAS) - (06/04)
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