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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608821
Report Date: 06/19/2024
Date Signed: 07/22/2024 03:19:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2021 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20210629084257
FACILITY NAME:WILLOUBEE RESIDENTIAL INC.FACILITY NUMBER:
197608821
ADMINISTRATOR:MARCUS WILLOUGHBYFACILITY TYPE:
735
ADDRESS:3559 EMERALD LANETELEPHONE:
(661) 941-9051
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Henry Coleman (House Manager)TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Resident sustained unexplained injuries.
Staff mismanaged residents' PNI funds.
INVESTIGATION FINDINGS:
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This is an amendment of the original report issued on 06/19/24. Report was amended due to change in LIC9099-D, 85165(a)-(b) and 80072(a)(1) to Type A instead of Type B and assessing an immediate civil penalty based on the seriousness and the risk of harm to clients in care. Findings for allegations mentioned above stay Substantiated. Licensing Program Analyst (LPA) Evelin Rios arrived to the faciltiy and met with house manger Henry Coleman. Administrator Assistant, Jessica Hernandez was contacted by telephone. LPA informed Jessica the reason for the visit. Henry was designated to sign todays report.
Previous visits were conducted on 06/30/21, 09/10/22, 11/08/22 and 03/05/24, phone interviews were conducted on 06/30/21, 03/05/24, 04/12/24, 06/19/24 and a facetime call interview on 04/18/24. During these dates, contact was made with five (5) facility staff, four (4) clients, a family member, C1’s Consumer Service Coordinator (CSC), the medical hospital staff and the complainants. In addition, C1’s hospital medical records and facility client records were obtained and reviewed and the facility application and file from Community Care Licensing office was reviewed.
(Continued to LIC9099-C, Page 1 of 4)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 9
Control Number 31-AS-20210629084257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
VISIT DATE: 06/19/2024
NARRATIVE
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Allegation:Resident sustained unexplained injuries. It is alleged, that client #1(C1) sustained unexplained injuries. During the investigation, through documentation and interviews on the dates noted above it is stated that C1 has self-injurious behavior. This was observed in C1’s client records and the Needs and Service plan. It was observed that C1 was expressing aggressive behavior on 03/05/22 at the facility, as well at the hospital stay of 03/05/22. In the Needs and Service plan it states C1 hits himself and falls to his knees. It was reported in interviews with C1’s CSC, other clients, and staff that C1 was seen to expresses behavior episodes of self-harm by falling to the ground, falling backwards, and banging his head on the wall, they stated it was done for attention or to get his way, or when he gets upset with staff. Staff report that C1 has punched holes in walls during aggressive episodes. Five of the five staff interviewed denied they hurt C1. Staff stated that when C1 has a behavior incident and becomes aggressive with staff or other clients, CPI training technics are used, like putting client on the ground. Per Administrator Jessica Hernandez CPI is no longer used at the facility with clients, and when asked by the department LPA staff for proof of training, Jessica stated staff Henry Coleman no longer had a copy of the card to show proof of training. A review of the facility file was done to verify the training that would be required at this facility for behavior episode such as with C1. After the file review was conducted in Community Care Licensing office, there was no record found in the file that CPI training would be used, at the facility. Staff reported during interviews that C1 would try to tackle male staff. It was stated during interviews that staff were seen dragging C1 and at times C1 was dragged outside, to prevent him from doing stuff in the facility or to keep other residents away from him. It was reported in interviews that some staff are manipulative, and some staff will say certain things that trigger the clients.

In an interview with C1, he reported that the bruises on him during the 03/05/22 hospital stay were from staff hitting him and would kick him on his hips. He also stated when he would get upset at staff he would fall onto the ground onto his knees or backwards. In an interview with C1’s family member, it was stated, C1 told them, that C1 would be dragged whenever he would fall to the floor. On 03/05/22, C1 had an outburst with staff which caused C1 to break a window.

(Page 2 of 4)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 31-AS-20210629084257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
VISIT DATE: 06/19/2024
NARRATIVE
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C1 was sent to the hospital for a 5150 danger to self or others, he was kept at the hospital on a psychiatric hold. During the incident of 03/05/22, it was documented in pictures in hospital medical records and in an interview with hospital staff that C1 was observed with bruising, from shoulder to toes. Wounds and bruising were documented and said to be at different stages and in colors from pink, purple and brown. Bruises in pictures were along the back, arms, knees, and head. The facility staff stated to the hospital staff that the injuries are self-inflicted. It was observed in the hospital notes that the Emergency Medical Services (EMS) reported that on the date of the incident of 03/05, they observed this to be a new behavior for C1, they reported that, “C1 was assaultive”. In the hospital notes it was observed that on 03/09/22, C1 was swearing at the security and threatened to assault the security personnel by punching them. During this hospital stay, the hospital doctors did increase one of C1’s medication from .5mg 2 x a day to, 1 mg 3 x’s a day. This medication was for agitation.

Based on the information gathered, there is sufficient information to corroborate that the injuries that are said to be unexplained are from C1, who did pose self-injurious behavior, and from staff who failed to use proper behavioral training, which was confirmed by C1 and witnesses that C1 was dragged by staff, which may have added additional injuries onto C1. Therefore, this allegation is deemed Substantiated at this time.

Allegation: Staff mismanaged residents' PNI funds. It is alleged, that C1 was having to pay staff from C1’s Personal and Incidental funds (P&I), and that C1’s funds were being mishandled or mismanaged. During the investigation, C1’s Personal and Incidental (P&I) records (RECORD OF CLIENT'S/RESIDENT'S SAFEGUARDED CASH RESOURCES - LIC 405) were reviewed for the years 2021 and 2022, and interviews were conducted with 5 staff, Consumer Service Coordinator from Regional Center, family member, and 2 clients. It was reported in an interview with C1’s family member and confirmed by staff that there were dollar amounts in the sums of $50, $25, $50 on a board in C1’s room which stated C1 owed these amounts of money to staff. When staff were asked during the interviews about the money, all staff stated it was only a joke. When the CSC was questioned during an interview if there was a concern about staff misusing C1’s money, he stated that there was no issue regarding money being misused by staff, as staff know they cannot borrow from the clients. During an interview with one client, they denied all the following, that staff ask the client for money, that they lend staff money or never has seen other clients lend staff money. During the interview with C1’s family member they stated that C1 told them that C1 is made to pay for staff’s lunch. Per staff, C1 refused his food so his sister would come to get him food. (Page 3 of 4)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 31-AS-20210629084257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
VISIT DATE: 06/19/2024
NARRATIVE
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During the P&I records review, a comparison was conducted of the receipts against the LIC 405 document for years 2021 and 2022. It was observed that each receipt amount matched what was logged onto the LIC 405 document. Although specific items on each receipt were reviewed further in detail. It was discovered that there were concerns with regards to what was purchased and other details, such as delivery address and information that was whited out on the receipts for C1. Multiple items purchased for C1 were questionable. Some of the concerns were as follows; a receipt charged to C1 was paid with a SNAP card, on food purchase receipt dated 01/29/21 it was made at 10:36pm and C1 confirmed clients would be put into the rooms around 7pm, this food was paid with a credit card by Jessica Hernandez. Other items of concern were purchases made for toddler age, and these items were sent to a home on Firenze St, which is not the facility address, multiple shoes charged to C1’s PNI funds were bought smaller than the shoe size of C1, C1 was charged for a mattress cover pad and the order was sent to another address. The receipt of 01/10/22 from TJ Maxx had multiple questionable items such as Treatment/Colo - 2 @ $4.99, Seasonal Dec. $7.99, Seasonal Dec $9.99, Treatment/Colo $4.99, Beauty Access $5.99, Decorative Acc $9.99, 6 items INF & Toddlers @ $9.99 each, Stationary $12.99. Another concern was multiple receipts had information whited out and one large sum receipt did not have an item description to identify what was purchased by C1. 2 other receipts of concern were for cubicles and shelving that were said to be purchase for or by C1 to which C1 denied during an interview that it was in C1’s room, this receipt had the delivery address whited out. During the interview with C1 and his family member, they also confirmed the shoe size of C1, they confirmed what activities C1 enjoyed doing, confirmed that the room cubicles were not in C1’s room, and confirmed that C1 never purchased infant / toddler item.

Based on the investigation, there is sufficient information to corroborate, the allegation that staff mismanaged P&I funds, therefore the finding is Substantiated at this time.

An immediate civil penalty of $500 will be assessed today for staff witnessed dragging C1 which may have contributed in C1 sustaining injuries. The administrator assistant was informed that additional civil penalties may be assessed based on Health and Safety Code 1548(a),1548(e) or (f), 1548 (f)(1)(A).

Exit Interview conducted. Deficiency cited (refer to LIC 9099-D), Civil Penalty assessed (Refer to LIC421IM) Appeal Rights provided. Copy of report provided.


(Page 4 of 4)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2021 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20210629084257

FACILITY NAME:WILLOUBEE RESIDENTIAL INC.FACILITY NUMBER:
197608821
ADMINISTRATOR:MARCUS WILLOUGHBYFACILITY TYPE:
735
ADDRESS:3559 EMERALD LANETELEPHONE:
(661) 941-9051
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jessica HernandezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Resident personal rights were violated.
Resident lost an excessive amount of weight while in care due to neglect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Evelin Rios arrived to the faciltiy and was granted access by staff. LPA met with the facility Administrator Assistant Jessica Hernanadez and House Manager, Rashayla Hayes to conduct an unannounced subsequent complaint visit to deliver the findings regarding the allegations, listed above. An entrance interview was conducted.

LPAs conducted a physical plant tour to ensure health and safety of the clients. No issues or concerns observed.
Previous visits were conducted on 06/30/21, 09/10/22, 11/08/22 and 03/05/24, phone interviews were conducted on 06/30/21, 03/05/24, 04/12/24, 06/19/24 and a facetime call interview on 04/18/24. During these dates, contact was made with five (5) facility staff, four (4) clients, a family member, C1’s Consumer Service Coordinator (CSC), the medical hospital staff and the complainants. In addition, C1’s hospital medical records and facility client records were obtained and reviewed and the facility application and file from Community Care Licensing office was reviewed. (Continued to LIC9099-C, Page 1 of 3)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 31-AS-20210629084257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
VISIT DATE: 06/19/2024
NARRATIVE
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Allegation: It is alleged, resident lost an excessive amount of weight while in care due to neglect. During the investigation, through documentation and interviews it is reported that C1 was noted as stocky, and under the Needs and Service Plan documentation it notates “overweight” under the physical/health section. Interviews of staff indicated that C1 had wanted to lose weight and stopped having soda every day. He had also started one mile walks every Tuesday and Thursday. He was described by staff as heavy set. The Administrator Assistant, Jessica Hernandez stated that the weight of C1 was brought up to C1’s doctor who didn’t think it was a problem. House Manager Staff stated C1 refused eating food at the facility, or anything but cereal. Consumer Service Coordinator (CSC), Frank Bertz stated C1 was seen on a regular basis by the doctor and a weight loss issue was never raised. One of the staff who was interviewed claimed C1 would eat good food and claimed C1 was diabetic, there was no documentation to confirm this diagnosis. Staff stated C1 didn’t like oatmeal, he always wanted something else for breakfast. C1 did eat, but it depended on his mood. Staff felt C1 was at a good weight, and claimed the doctor said C1’s weight was fine. Records of C1 from the facility show a weight loss with in a three (3) year span of 20 pounds, from 2018 to 2021. During the hospital stay March 2022 the records state C1 weighed 149.91 lbs. From the time of 2021 records at the facility to the hospital stay in March 2022, C1 had a weight loss of 21 lbs, with a total weight loss of 41 lbs. over four (4) years. In the Individual Program Plan (IPP), it states that C1 has met his goal to lose weight.

Based on the information gathered, there is not sufficient evidence to corroborate the allegation of C1 losing excessive weight was due to neglect, therefore the finding is Unsubstantiated at this time.

Allegation: Resident personal rights were violated. It is alleged that the facility staff withheld the clients remote and facility phone from C1. During the investigation, staff stated that C1 had his own television remote to his Roku which he used until he threw it, and it broke. C1 was than loaned the staffs remote control to use, but he was also misusing it, he was throwing the staff borrowed remote, and he was using it as a weapon. This is when staff removed it, and it was given back, to staff. All five staff that were interviewed denied that the remote was ever removed from C1 as a form of punishment.

(Page 2 of 3)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 31-AS-20210629084257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
VISIT DATE: 06/19/2024
NARRATIVE
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Regarding the phone usage, all five staff confirmed that C1 had access to the facility home phone. When asked about a personal cell phone for C1, it was stated it would be provided by C1’s family and it is not the responsibility of the facility to provide a personal cell phone to C1. Complainant stated that they talked to Administrator about getting R1 a cell phone. Administrator stated, “Let’s wait on that until we have a meeting with the Regional Center.” At a meeting on 07/13/2021, CSC stated, family said it would not be a good idea to have a cellphone since they believed C1 would be tempted to constantly call them. They reached an agreement that it would only be the facility telephone.

Based on the information gathered, there is not sufficient evidence to corroborate the allegation that C1 had their personal right violated by staff withholding the phone or the tv remote, therefore the finding is Unsubstantiated at this time.

Exit interview conducted. Copy of report provided.
(Page 3of 3)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 9
Control Number 31-AS-20210629084257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2024
Section Cited
CCR
80072(a)(1)
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(a) ...each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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C1 is no longer living in the facility. Administrator and Administrator Assistant agreed to In house Personal Rights training for all staff. Facility will provide training materials and a copy of staff sign in sheet to LPA by POC due date 07/10/2024.
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Based on interviews conducted and record review it was found that C1 participated in self injurious behavior, and staff was witnessed dragging C1, which posed an immediate health and safety risk to clients in care.
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Type B
06/28/2024
Section Cited
CCR
80066(a)(6)
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(a) The licensee shall ensure that personnel records are maintained on ... each employee. Each personnel record shall contain the following information:
(6) Documentation of the educational background, training...This requirement was not met as evidenced by:
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Administrator and Administrator Assistant agreed to provide a written statement of understanding of the regulation cited and how they will maintain each employees file current or archived moving forward by POC due date 06/28/2024
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Based on interviews conducted and record review it was found that at least one (1) staff would use Crises Prevention techniques but facility could not provide a copy of proper certification, which posed a potential health and safety risk to 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.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 31-AS-20210629084257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2024
Section Cited
CCR
85165(a)-(b)
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(a)The licensee shall ensure staff who use, participate in, approve. or provide visual checks of manual restraint or seclusion only use techniques specified in the Emergency Intervention Plan and which are not prohibited in Section 85102. (b) Staff who use, participate in, approve or provide visual checks of manual restraint or seclusion, shall have a minimum of sixteen hours of emergency intervention training and be certified for having successfully completed the training. This requirement was not met as evidenced by:
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Assistant Administrator agreed the facility will act on current Plan of Operation/Program procedures in regards to emergency intervention. CPI certification will not be required by staff.
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Based on interviews conducted and record review the licensee did not ensure that the facility had an Emergency Intervention Plan for when C1 would behave in self-injuries and assaultive behavior with staff and other clients, which posed an immediate health and safety risk to clients in care.
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Type B
07/10/2024
Section Cited
CCR
80026(h)(1)(B)
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(h) Each licensee shall maintain accurate records ... not limited to the following: (1)Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order. (B)The store receipt shall constitute the receipt for purchases made for the client from his/her account. This requirement was not met as evidenced by:

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Administrator stated that all staff who assist clients with P&I money will receive in-service training and the verification of in-service training will be submitted to LPA by 07/10/2024.
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Based on interviews conducted and record review the licensee did not ensure that proper documentation was maintained for C1's purchases and purchases made were really made on behalf of C1, which posed a potential health and safety risk to clients in care.
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When appropriate, Assistant Administrator agreed to include detailed information about purchases made such as a narrative of credit card being used to purchase an item online or a purchase of a prepaid cared to make purchases online.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC9099 (FAS) - (06/04)
Page: 9 of 9