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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881177
Report Date: 10/02/2023
Date Signed: 10/02/2023 03:50:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/26/2023 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230926143829
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: 11DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
08:18 AM
MET WITH:Sandra Richardson, Chief Administrative OfficerTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff does not allow resident to smoke.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to initiate an investigation and deliver the finding on the above allegation. LPA met with Chief Administrative Officer Sandra Richardson and explained the purpose of the visit. The investigation included file reviews, facility tour, and interviews with relevant parties.

The allegation was that the facility staff did not allow resident #1 (R1) to smoke. LPA Nickolas' interview with the chief administrative officer revealed that they denied this allegation. LPA Nickolas' interview with staff #1 (S1) revealed that they denied this allegation. LPA Nickolas' interview with staff #2 (S2) denied this allegation. LPA Nickolas' interview with staff # 3 (S3) confirmed this allegation. LPA Nickolas' interview with staff #4 (S4) denied this allegation. LPA Nickolas' interview with R1 revealed that they confirmed this allegation. LPA Nickolas' interview with resident #2 (R2) revealed that they confirmed this allegation. LPA Nickolas' interviews with residents #3 (R3) and #4 (R4) revealed that they do not smoke.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
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 5
Control Number 56-AS-20230926143829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: AMETHYST BEHAVIORAL HEALTH, LLC
FACILITY NUMBER: 361881177
VISIT DATE: 10/02/2023
NARRATIVE
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During this investigation, LPA Nickolas discovered through interviews with staff and residents that the facility had changed its smoke breaks policy. The facility has reduced the number of smoke breaks residents are allowed to have in response to residents not smoking in the designated smoking area.

Based on the evidence gathered during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conduct were a copy of this report (LIC 9099), LIC 9099D, and appeal rights were discussed and provide.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20230926143829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: AMETHYST BEHAVIORAL HEALTH, LLC
FACILITY NUMBER: 361881177
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2023
Section Cited
CCR
81072(a)(3)
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81072 Personal Rights (a)(3)
To be free from corporal or unusual punishment, infliction of pain, humiliation...

This requirement was not met, as evidence by the following:
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The chief administrative officer shall ensure that all staff are adequately trained on the cited section. Chief administrative officer shall submit signed training records to the regional office RO by POC( 10/16/2023). The chief administrative officer also stated that they will review their current
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Based on interviews and file reviews, the facility did not protect the personal rights of some residents in care by reducing the residents' smoke breaks, which poses a potential health and safety risk to persons in care.
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**continued**

smoke break policy for possible revision and submit new policy to licensing for approval at a later date.
HSC
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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: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/26/2023 and conducted by Evaluator Rayshaun Nickolas
COMPLAINT CONTROL NUMBER: 56-AS-20230926143829

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: DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
08:18 AM
MET WITH:Sandra Richardson, Chief Administrative OfficerTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff inappropriately strip searches resident.
Staff threatened resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to initiate an investigation and deliver the finding on the above allegations. LPA met with Chief Administrative Officer Sandra Richardson and explained the purpose of the visit. The investigation included file reviews, facility tour, and interviews with relevant parties.

Allegation #1 “Staff inappropriately strip searches resident”. The allegation alleged that the facility staff members stripped and searched resident #1 (R1). LPA Nickolas' interview with the chief administrative officer revealed that they denied this allegation. LPA Nickolas' interview with staff # 1 (S1) and staff #4 (S4) revealed they denied this allegation. LPA Nickolas' interview with staff # 2 (S2) and staff # 3(S3) revealed that they denied this allegation. However, S2 and S3 stated that R1 told them this occurred. LPA Nickolas' interview with R1 revealed that they confirmed this allegation. LPA Nickolas' interview with resident # 2 (S2) and resident #3 (S3) denied this allegation. LPA Nickolas' interview with resident #4 (R4) denied this allegation but admitted that R1 told them they were strip-searched. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20230926143829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: AMETHYST BEHAVIORAL HEALTH, LLC
FACILITY NUMBER: 361881177
VISIT DATE: 10/02/2023
NARRATIVE
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Allegation #2 “Staff threatened resident”. The allegation alleged that the facility staff members took all of R1's belongings and threatened to throw them in the street. LPA Nickolas' interview with the chief administrative officer revealed that R1's personal belongings were safeguarded during their away without leave (AWOL). The chief administrative officer denied threatening to throw R1's belongings in the street. LPA Nickolas' interview with S1 revealed that R1's personal belongings were safeguarded during their AWOL. S1 denied threatening to throw R1's belongings in the street. LPA Nickolas' interview with R1 confirmed this allegation. LPA Nickolas interviews with R2, R3, and R3 revealed that they denied this allegation. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and copy of this report was provided.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5