370808597-9-21-2022-08-AS-DPOL-CJQU58-20220929151617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370808597
Report Date: 09/21/2022
Date Signed: 09/21/2022 02:04:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2022 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220316092057

FACILITY NAME:	STONE MOUNTAIN RANCH		FACILITY NUMBER:	370808597
ADMINISTRATOR:	ROBINSON, DEZI		FACILITY TYPE:	735
ADDRESS:	16585 HIGHLAND VALLEY ROAD		TELEPHONE:	(760) 789-4600
CITY:	RAMONA	STATE: CA	ZIP CODE:	92065
CAPACITY:	15	CENSUS: 13	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Elena O'Connor, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Licensee did not keep authorized representative informed regarding client's care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegation. LPA was granted entry to the facility by Elena O'Connor, Executive Director, after identifying herself and explaining the reason for the visit.

On April 16, 2022, it was alleged that the facility did not inform a client’s authorized representative of a care issue, specifically of a lapse in medication. The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

[Continued on LIC9099-C, Page1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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 2

Control Number 08-AS-20220316092057

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: STONE MOUNTAIN RANCH	FACILITY NUMBER: 370808597
	VISIT DATE: 09/21/2022

NARRATIVE

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[Continued from LIC9099, Page 2 of 2]

Client 1 (C1) had lived at the facility since February 17, 2001. Facility records and outside sources confirmed that C1 was prescribed to take Quetiapine, an antipsychotic, for at least the past 10 years. The medication had been prescribed by the same physician (PCP) for the past 10 years. Facility records revealed that, on April 9, 2020, C1’s authorized representative (AR) had instructed the facility that PCP was not allowed to prescribe medication for C1. Facility records also show that these instructions were repeated on January 21, 2022. AR had also limited the facility’s communication with C1’s heath care providers. On April 9, 2020, AR informed the facility that they only had authorization to schedule appointments that AR had previously consented to. Outside source interviews also revealed that AR had requested health care providers only communicate with AR.

Facility’s Medication Administration Record (MAR) recorded that C1 did not receive Quetiapine in January 2022. Instead, staff signed a handwritten note that stated, “No refills available. [PCP] is not seeing [C1]. Dr [unintelligible]'s office would not prescribe."

Outside source interviews revealed that C1’s pharmacy was not accepting refills by PCP as requested by AR beginning 2021. The pharmacy requested a prescription for Quetiapine to a doctor approved by AR. On January 11, 2022, the pharmacy received a prescription for C1 for Quetiapine by the new doctor. Outside source interviews revealed that the pharmacy filled the prescription but did not inform the facility that it was available. On January 25, 2022, staff went to pick up medications for the facility and discovered C1’s Quetiapine. The MAR for February 2022 verified that Quetiapine was administered to C1 as prescribed.

Based on the evidence obtained during the complaint investigation, the allegation that the facility did not inform the authorized representative of a lapse in medication is found to be UNSUBSTANTIATED, meaning that there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director; a copy of this report and Licensee's Rights (LIC9058) were provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2