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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610300
Report Date: 03/22/2023
Date Signed: 03/22/2023 04:33:10 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
03/16/2023 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20230316161500
FACILITY NAME:QUEST BEHAVIORAL HEALTH INCFACILITY NUMBER:
197610300
ADMINISTRATOR:MELIKYAN, ARMENFACILITY TYPE:
772
ADDRESS:43828 47TH STREET WESTTELEPHONE:
(661) 579-6666
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 2DATE:
03/22/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Armen MelikyanTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Licensee failed to obtain proper signature from the licensee or the licensee's designated representative on the admission agreement.
Licensee failed to properly develop a treatment/rehabilitation plan for resident(s).
Staff failed to review client's treatment/ rehabilitation plan at least weekly.
Licensee failed to document staff training.
INVESTIGATION FINDINGS:
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On 03/22/2023 at 3:00 p.m. LPA Rios arrived the facility mentioned above to conduct an announced complaint investigation. LPA was greeted by staff #2 (S2) and granted access. LPA met with Executive Director Armen and explained the reason for the visit. At 3:10 p.m. LPA interviewed Armen and Satff #1 (S1). At 3:20 p.m. LPA took a tour of the facility to assure the health and safety of the residents in care. No issues were found at time of visit.

Allegation #1: Licensee failed to obtain proper signature from the licensee or the licensee's designated representative on the admission agreement.

It is alleged one (1) open client admission agreement did not contain documented evidence that it was signed on entry by program representative. Record reviewed by LPA was a report for an on-site program certification review completed on 02/21/2023 by the Department of Health Care Services (DHCS).

(Continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
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 4
Control Number 31-AS-20230316161500
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: QUEST BEHAVIORAL HEALTH INC
FACILITY NUMBER: 197610300
VISIT DATE: 03/22/2023
NARRATIVE
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The report consisted of a Notice of Noncompliance and a Plan of Correction (POC). LPA confirmed with Executive Director, DHCS, had conducted a visit. According to S1, she conducted her own review of the admission agreement a few days later after client's entry and found a representative signature was missing. S1 immediately had representative sign admissions agreement. Based on interviews and records review there is sufficient information to support this allegation. Therefore, this allegation is deemed to be SUBSTANTIATED at this time.

Allegation # 2: Licensee failed to properly develop a treatment/rehabilitation plan for resident(s).
It is alleged two (2) open client treatment/rehabilitation plans did not contain documented evidence that they were prepared with the client. LPA review of DHCS report and confirmation from S2 that two open clients did not sign plans but they did assist in treatment plan. Information was noted on the comments section of the plans with date and time client met with representative with no signature. Based on interviews and records review there is sufficient information to support this allegation. Therefore, this allegation is deemed to be SUBSTANTIATED at this time.

Allegation #3: Staff failed to review client's treatment/ rehabilitation plan at least weekly.
It is alleged one (1) open client treatment/rehabilitation plan was not completed at least weekly. LPA review of DHCS report and confirmation from S1 that one (1) open client completed plan on the 8th day. Based on interviews and records review there is sufficient information to support this allegation. Therefore, this allegation is deemed to be SUBSTANTIATED at this time.

Allegation #4: Licensee failed to document staff training.
It is alleged that staff did not have evidence of completed training for preparing various documents in the facility. LPA reviewed the report from DHCS, and S1 confirmed although they are a licensed professional, training for completing various documents was not completed and not on file. Based on interviews and records review there is sufficient information to support this allegation. Therefore, this allegation is deemed to be SUBSTANTIATED at this time.

Deficiencies cited on LIC 9099 D. Appeal Rights explained. Exit Interview conducted. Copy of report emailed to Executive Director.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20230316161500
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: QUEST BEHAVIORAL HEALTH INC
FACILITY NUMBER: 197610300
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2023
Section Cited
CCR
81068(d)
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81068(d)Such agreements shall be dated and signed, acknowledging the contents of the document, by the client and the client's authorized representative and the licensee or the licensee's designated representative...
This requirement is not met as evidenced by:
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Licensee had corrected POC before visit.
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Based on LPA's interviews and record review, the licensee failed to obtain a representative signature within 7 days of the clients entry. This which posed a potential health, safety and personal rights risk to residents in care.
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Type B
03/22/2023
Section Cited
CCR
81068.2(b)(3)
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81068.2(b)(3)A written treatment/rehabilitation plan...The program and client shall together develop a written treatment/rehabilitation plan ...
This requirement is not met as evidenced by:
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Licensee had corrected POC before visit.
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Based on LPA's interviews and record review, the licensee failed to obtain a open two client signatures on treatment/rehabilitation plans as evidance that it was developed together with the representative. This which posed a potential health, safety and personal rights risk to residents 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: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20230316161500
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: QUEST BEHAVIORAL HEALTH INC
FACILITY NUMBER: 197610300
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2023
Section Cited
CCR
81068.3(d)
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81068.3 (d)(3)(A)The program director or staff person specified in (a) above shall, with the client's participation...(3) Documentation of reviews by staff and client of the treatment/ rehabilitation plan adhering to the following schedule:(A) Short-Term Crisis Residential Treatment Program: at least weekly. This requirement is not met as evidenced by:
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Licensee had corrected POC before visit.
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Based on record review and interviews, Licensee did not comply with the above section by failing to adhere to a weekly schedule for one open client, which posed a potential health, safety and personal rights risk to residents in care.
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Type B
03/22/2023
Section Cited
CCR
81066(b)
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81066(b) Staff training as required by Section 81065(r) shall be documented. Documentation shall include the subject of the training, who conducted the training, and the date(s) of the training. This requirement is not met as evidenced by:
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Licensee had corrected POC before visit.
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Based on record review and interviews, Licensee did not comply with the above section by failing to conduct and document training required by California Code Regulations Title 9, ยง 532.2, which posed a potential health, safety and personal rights risk to residents 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: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4