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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881177
Report Date: 02/21/2023
Date Signed: 04/26/2023 03:50:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/14/2023 and conducted by Evaluator Magda Malcore
COMPLAINT CONTROL NUMBER: 56-AS-20230214172643
FACILITY NAME:AMETHYST BEHAVIORAL HEALTH, LLCFACILITY NUMBER:
361881177
ADMINISTRATOR:RICHARDSON, SANDRAFACILITY TYPE:
772
ADDRESS:921,923,925 TRIBUNE STREETTELEPHONE:
(909) 809-9293
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:12CENSUS: 12DATE:
02/21/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Sandra Richardson, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff yelled at residents
INVESTIGATION FINDINGS:
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***This is an admended report. The original document was signed and dated on 2/21/23***
Licensing Program Analyst (LPAs) Magda Malcore and Bernadette Allen made an unannounced visit to the facility to conduct a complaint investigation and deliver findings regarding the above allegation. LPAs Malcore and Allen met with Program Director Tanisha Cooper and discussed the purpose of the visit. Administrator Sandra Richardson arrived later and LPAs discussed the purpose of the visit.

The investigation consisted of observations, interviews with residents and staff. Regarding the allegation above, LPAs interviewed eleven (11) residents, four (4) residents confirmed that staff 1 (S1) yells at them. Interviews with three (3) staff members were conducted and two (2) staff members stated that (S1) has yelled at residents in care. Upon arriving LPAs did observe (S1) speaking loudly to residents in care.
Based on observations and interviews conducted with staff members and residents, the above allegation is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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 3
Control Number 56-AS-20230214172643
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AMETHYST BEHAVIORAL HEALTH, LLC
FACILITY NUMBER: 361881177
VISIT DATE: 02/21/2023
NARRATIVE
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A deficiency was cited at the time of visit. LIC9099-C and 9099-D.

An exit interview was conducted with Administrator, Sandra Richardson and a copy of the report was provided at the conclusion of the visit with appeal rights
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20230214172643
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: AMETHYST BEHAVIORAL HEALTH, LLC
FACILITY NUMBER: 361881177
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2023
Section Cited
CCR
81072(a)(1)
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Personal Rights-To be accorded dignity in his/her personal relationships with staff and other persons. This regulation was not met as evidenced by: The residents in care have stated that staff members yell at them while in care.
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The licensee has agreed to provide additional training regarding the residents personal rights and provide a written statement of understanding signed by all staff members confirming their understanding of the regulation cited by the POC date of 2/28/2023 by the COB.
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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: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3