370808597-6-19-2024-08-AS-LTEZ-D6MRBS-20240627125312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370808597
Report Date: 06/19/2024
Date Signed: 06/19/2024 02:48:27 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
10/22/2020 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20201022083738

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:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Elena O'Connor, Program Manager		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff misused client's personal funds.

Staff are making medical decisions for client without authorization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigation findings. LPA was granted entry into the facility and met with Elena O'Connor, to whom LPA disclosed the reason for the visit.

It was reported to Community Care Licensing (CCL) that facility staff misused Client 1’s (C1) funds by spending money on big ticket items like outings without getting the responsible party’s approval and administered a chemical laxative to C1, although C1’s responsible party instructed staff to use a natural fiber program.

CCL has investigated the above-listed complaint allegations. The investigation consisted of a tour of the facility, review of facility and outside source records, and interviews of staff and client. A review of records obtained during the investigation reflected that expenditures on behalf of C1 were documented, and LPA

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20201022083738

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: 06/19/2024

NARRATIVE

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found no discrepancy or use of funds on items that were not for the benefit of C1’s care and wellbeing. Evidence obtained during the investigation reflected that C1 consented to participation in outings on which funds were expended; the investigation did not yield evidence that C1 was not able to give consent to participate in outings and activities for which C1’s personal funds were utilized.

It was also alleged that a chemical laxative was administered to C1, although C1’s responsible party directed facility staff to utilize a natural fiber program. A review of C1’s medical records revealed that C1’s physician prescribed medication that acts as a laxative for constipation to be administered on a routine basis. Licensee nor facility staff have the ability to disregard administration of medication prescribed for the client at the direction of the client’s responsible party or any other party. Discontinuance of medication or change in physician’s orders can only be effectuated at the direction of C1’s physician.

Based upon all of the foregoing, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Elena O'Connor, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Program Manager at the conclusion of the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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