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32 | Regarding the allegation that, client funds are being mishandled, the following has been concluded: During the initial complaint visit conducted on February 26, 2025, the Department reviewed the Personal and Incidental (P&I) expense monies for all four clients. The Department observed there were no discrepancies in the P&I. During the subsequent complaint visit conducted on October 10, 2025, the Department reviewed the P&I for all four clients. The Department observed there were no discrepancies in the P&I. The Department conducted six staff interviews. Six out of the six staff interviewed denied the allegation that client funds are being mishandled. The Department also contacted the family's for all four clients, but was only able to speak with two. Two out of the two family interviews conducted denied there being any issues with the client's P&I.
Regarding the allegation that, facility is not following staffing ratio per clients needs, the following has been concluded: The Department reviewed the files for all four clients in care. The Department reviewed documents such as client Identification sheets, Admission agreements, Physician's reports, Individual Program Plans (IPP), Client Development Evaluation Report, and Behavioral analyst reports. The Department observed that all four clients require twenty four hours supervision, seven days a week. The Department observed that Client #3 (C3) is on a one staff to one client ratio during daytime hours. The Department observed that Client #1 (C1), Client #2 (C2), and Client #4 (C4) attend their respective Day Programs during the day and are not at the facility during daytime hours. The Department observed that all four clients are on a one staff to two client ratio when all clients are present at the facility. The Department reviewed the facility's LIC500 Personnel Report dated September 1, 2025, and observed there are always a minimum of two staff present and on duty when client are home, including over night shifts. The Department observed that are a sufficient amount of staff present at all times during the week to provide supervision to the clients in care. The Department also contacted the family's for all four clients, but was only able to speak with two. Two out of the two family interviews conducted also confirmed that there are a sufficient amount of staff present at all times to provide supervision to the clients in care.
Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the three allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Joshua Estrevillo and a copy of the report was provided. |