045002777-12-13-2023-59-AS-KHOS-CZ7MSR-20240105085221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002777
Report Date: 12/13/2023
Date Signed: 12/13/2023 01:21:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20231004094822

FACILITY NAME:	RAVEN RESIDENTIAL		FACILITY NUMBER:	045002777
ADMINISTRATOR:	LEAK, LAUREN		FACILITY TYPE:	735
ADDRESS:	585 BREARCLIFFE DRIVE		TELEPHONE:	(530) 736-0980
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	4	CENSUS: 4	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Lauren Leak -licensee		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff is hitting resident in care - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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12/13/2023 01:00 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with licensee / administrator Lauren Leak. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the licensee / administrator, 5 facility staff, and 2 day program staff. LPA reviewed the following documents: staff list with telephone numbers, client list, Physician’s report, Admission Agreement, IPP for 1 client, related incident reports, photographs, text message.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20231004094822

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: RAVEN RESIDENTIAL	FACILITY NUMBER: 045002777
	VISIT DATE: 12/13/2023

NARRATIVE

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Staff is hitting resident in care – UNSUBSTANTIATED

It was reported that a client who lives in the home is saying a staff is hitting them.

LPA reviewed C1’s Individual Program Plan (IPP) which states that Client 1 (C1) has self-injurious behaviors that include banging their head and hitting their head against a wall. This occurs when C1 is upset or has a high level of anxiety. IPP states that C1 requires constant supervision for their safety.

LPA reviewed a text message sent on 08/25/2023 at 2:38 PM from a staff which stated “Where did you see that bruise on C1? Their left leg? Cause C1’s saying they fell on the bus today.”

LPA reviewed photographs that included C1’s right hand showing very jagged nails, thin scratches on C1’s torso, a bruise on C1’s hip, and on the back of their leg.

Staff interviews revealed that staff have seen scratches and bruises on C1. Staff stated that C1 has said that S1 hit C1. No staff have witnessed S1 abuse C1. S1 stated C1 has said many different staff who work in the facility have hit them.

Day program staff stated When C1 first started attending program they had scratches on their stomach that looked fresh and they notified the facility administrator. Staff stated that C1 does a lot of self-injurious behavior, when they get mad they punch themselves in the forehead and on their thigh depending on if they are standing or sitting. Day program staff have not witnessed C1 scratching themselves.

Administrator stated A couple of months ago C1 said that S1 hit them. C1 repeats whatever the last thing is that you say. I asked C1 if S1 hit them on their arm and C1 said “S1 hit me on my arm.” I asked C1 if S1 hit them on their leg and C1 says “S1 hit me on my leg.”

It was determined that C1 is known to engage in self-injurious behaviors, C1 does have scratches and bruises. No one has witnessed staff hitting or abusing C1, there is no evidence to support that staff abused C1. This allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to licensee / administrator Lauren Leak.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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