A Sacramento agency running one of the few remaining foster care shelters in California has violated health and safety laws and the personal rights of children more than 120 times in recent years — a number matched only by state-licensed facilities that have been shut down or placed on probation.

State citations since 2012 at the Children’s Receiving Home of Sacramento describe poorly trained staff, mishandled medications and filthy dorms. This year, an employee was terminated for an “inappropriate relationship” with an underage client and for smoking marijuana with runaway foster youth. On Sept. 8, a state inspector was unable to remain in a bedroom because the stench of urine overwhelmed her.

The privately run facility has a troubled history of poor performance it has not yet overcome. Three years ago, state regulators placed the Receiving Home on an extensive 12-month correction plan, after its failure to make earlier, promised reforms.

Supervisors “failed to report multiple allegations of sexual and other inappropriate conduct by staff toward clients at the facility”; children were assaulted and injured due to lack of care and supervision; and staff failed to call 911 when a child nearly drowned in the facility’s pool, a January 2014 letter from the California Department of Social Services states.

The number of citations at the 89-bed facility on Auburn Boulevard “doesn’t surprise me, not at all. It sounds about right,” said foster youth Malik Pinckney, 18, who was sent as a younger teen to the Receiving Home campus. “It’s almost like they want to get shut down, like they don’t think people are going to check. It’s just neglectful, pure neglect, of everything at the place — the buildings, and the kids.”

Licensing violations can be found throughout California’s network of more than 900 children’s residential care facilities, which range from two to 216 beds. But the total number of citations at the shelter and adjoining residential programs run by the Children’s Receiving Home of Sacramento stands out, state records show, with a notably high number of violations that pose “an immediate risk.”

David Ballard, longtime CEO of the nonprofit Children’s Receiving Home, said his agency strives to provide the best of care for foster youth, and he attributed the high number of citations to particularly diligent reporting to state authorities.

“We’ve made a decision to err on the side of caution and over-reporting,” Ballard said. “If we think we have a problem, we don’t debate it here, we report it to licensing and they come out. That’s something we have asked for to make sure we have a crisp and clean operation.”

State and county officials declined to comment on the significance of the high number of citations, saying individual foster care facilities are unique and should not be compared.

A Chronicle investigation published this year revealed additional hazards for youth placed at the facility. The report documented hundreds of questionable arrests on shelter campuses following minor misbehavior by foster youth. In Sacramento, there were more than 40 instances of foster youth being arrested and booked at the county’s juvenile hall in 2015 and 2016 from the Children’s Receiving Home campus, including some children as young as 9 and 10.

Unlike group homes in California, which are shifting to short-term treatment centers, shelters simply house children that the foster care system can’t place. Most California counties have moved away from the shelter model, which is considered outmoded. Next year, just seven of the state’s 58 counties will operate shelters, under new requirements that children remain no more than 10 days.

The Sacramento facility, however, is expanding its services to accommodate more children, and is set to receive an additional $700,000 in county funding.

The Children’s Receiving Home is in some ways unique. Its main campus contains the 49-bed emergency shelter for newborns through children up to 18 years old, and several residential treatment programs. It also leases space to Sacramento County, which operates a central intake office where social workers and police bring children immediately after they’ve been removed from troubled homes.

As The Chronicle reported in July, for years, hundreds of children have been left to sleep on the floor of the county intake office, in an illegal, makeshift arrangement that left teenagers vulnerable to human trafficking in the neighborhood and other safety hazards.

Following exposure, county officials responsible for the intake office are now taking steps to end the illegal housing practice — mainly by shifting children with more challenging behaviors into the adjacent shelter, with one-on-one staffing and additional mental health services.

Pinckney, who now lives with a foster family, recalls some employees’ kindnesses at the Sacramento facility — granting extra time on the basketball court, or simply listening when kids needed to talk. But twice in 10 days, he said, “savage” fights broke out that counselors failed to break up with any urgency, and girls left campus alone late at night with no one trying to stop them. Pinckney described conditions in the dorms and bathrooms as “nasty.”

Although foster youths’ medical records are often hard to access amid their many moves, the Sacramento facility has repeatedly been cited for avoidable errors, such as an incident where a child was mistakenly given a sibling’s medications. Authorities also noted: “There have been numerous incidents in which clients did not receive their medications as prescribed due to errors, communication problems and medications not filled timely.”

In some cases, employees’ poor choices resulted in injuries, such as staff failing to take a child to the doctor in time to get stitches after a fight broke out.

State citations also reveal shortcomings in ensuring children are provided structured activities to make their lives in institutional care more normal and less dull. The facility has not “utilized an activity plan to keep the children engaged,” investigators noted in one report, canceling activities for some youth that prompted them to run away.

On rarer occasions, abuse by staffers has also been documented, including a former counselor sentenced to a year in jail in 2013 for having sex with a 16-year-old client and furnishing her with marijuana. Another citation for a staffer smoking marijuana with clients was issued just last month.

The licensing division of the state Department of Social Services responds to complaints and conducts inspections of residential care facilities. When citations are issued, a facility must submit a plan of correction. If those plans fail, the department has a range of enforcement options, from issuing citations and civil penalties to revoking a facility’s license.

Observers say the repeated violations in Sacramento illustrate troubling patterns. Pay at the Sacramento facility is the lowest among 10 shelter programs reviewed by the newspaper, with a starting hourly wage recently raised to $11.50 — $1 less than at the local In-N-Out Burger.

“It’s most disheartening that they haven’t cleaned up their act in any appreciable way — the staff has carte blanche to do whatever they want to do without any competent supervision by the administration there,” said Sacramento psychologist and attorney Joseph George, who represented the abused 16-year-old foster youth and whose office interviewed more than 18 former employees.

Director Ballard would not comment on specific staff abuse cases, but said he has been disturbed by the repeated incidents: “I’ve been very conscious of that, and I do see that pattern,” he said. Ballard said the facility has responded to each citation through termination, discipline, improved training or policy changes. “It’s still a work in progress, but my goal is to be responsive to the fact that I was seeing too many staff errors, and my goal is to see fewer errors.”

He later wrote to the newspaper to clarify those remarks, stating his facility “does critically needed work, for the best kids, delivered by the most dedicated staff, every day. We make mistakes. Everybody does. But the ledger here — the work itself — is overwhelmingly to the good.”

Sacramento County is heavily reliant on the Receiving Home to house foster youth who social workers have been unable to place with relatives or foster parents. The facility is well-known locally, visited regularly by local and state elected officials.

Yet citations in recent years include “dirt and grime” throughout bedrooms, and soiled shower stalls. At the cottage housing children 6 years old and younger, water ran as hot as 129.5 degrees, well above scalding temperature.

On Sept. 8, a state Licensing Program Analyst was repelled by what she found on an unannounced visit to a dorm: “Bedroom #5 has a very strong smell of urine and there were 6 flies observed over the bed of one of the clients,” she wrote. “The odor was so strong LPA was unable to stay in the room.”

Foster youth Pinckney, who is now studying music and psychology at Cosumnes River College in Sacramento, said the shelter environment led him to one conclusion: “You just don’t want to be there longer than you have to. It was just an overall terrible experience that I wouldn’t recommend for anybody.”

Karen de Sá, Cynthia Dizikes and Joaquin Palomino are staff writers on The San Francisco Chronicle’s Investigative Team. Email: kdesa@sfchronicle.com, jpalomino@sfchronicle.com, cdizikes@sfchronicle.com Twitter: @JoaquinPalomino, @cdizikes

Fostering Failure

Read The Chronicle’s in-depth, multimedia investigation of how California’s foster care shelters have criminalized hundreds of children: www.sfchronicle.com/fostering-failure

Contact The Chronicle’s investigative team: iteam@sfchronicle.com