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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603969
Report Date: 08/08/2022
Date Signed: 08/19/2022 07:52:29 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2022 and conducted by Evaluator Nicole Strickland
PUBLIC
COMPLAINT CONTROL NUMBER: 08-CR-20220323132124
FACILITY NAME:REFUGE, THEFACILITY NUMBER:
374603969
ADMINISTRATOR:HARRISON, AMANEECEFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 2DATE:
08/08/2022
UNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Grace WilliamsTIME COMPLETED:
03:31 PM
ALLEGATION(S):
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Staff purchased a vape pen for minor in care.
Staff made inappropriate comments to minor in care.
Staff purchased alcohol for minor in care.
INVESTIGATION FINDINGS:
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This is an amended report originally delivered on August 8, 2022.
On August 8, 2022 at 2:07 pm Licensing Program Analyst (LPA), Nicole Strickland, met with Grace Williams, Executive Director of The Refuge to deliver the finding for the above stated allegations. The investigation was conducted by Special Investigator (SI) Rey Lyyjoki and LPA Strickland and included interviews with one of one foster youth, three staff members (Staff #1 [S1], Staff #2 [S2], and Staff #3 [S3]), San Marcos Sherriff’s Detective and Executive Director (ExDir). In addition, county records and facility records were reviewed.

On March 23, 2022, Community Care Licensing (CCL) received two allegations alleging Staff (Staff #1 [S1]) purchased a vape pen for minor (Child #1 [C1]) in care and S1 purchased alcohol for minor (C1) in care. Specifically, it was reported on March 4, 2022, S1 took C1 to the store where S1 purchased alcohol and a vape pen for C1. Confidential interviews, record review, and observation of photographs taken of the video surveillance from the store provided consistent accounts of S1 making the purchases. Confidential
***CONTINUED ON NEXT PAGE***
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Natasha DunlapTELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Nicole StricklandTELEPHONE: (951) 805-0220
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
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 4
Control Number 08-CR-20220323132124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: REFUGE, THE
FACILITY NUMBER: 374603969
VISIT DATE: 08/08/2022
NARRATIVE
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***This is an amended document***
interviews and record review revealed S1 corroborated the purchases were intended for C1 and provided to C1.

An additional allegation alleging Staff (S1) made inappropriate comments to minor (C1) in care was also received by CCL. Specifically, it was reported S1 made inappropriate sexual comments to C1 on at least two occasions. Confidential interviews provided consistent statements of S1 making sexual comments to C1 about C1 and other staff working at the facility.

Based on confidential interviews and record review the allegations Staff (S1) purchased a vape pen for minor (C1) in care, Staff (S1) made inappropriate comments to minor (C1) in care, and Staff (S1) purchased alcohol for minor (C1) in care are substantiated. The preponderance of evidence standard has been met. Facility is cited for two violations Health and Safety Code 1550(c) Conduct Inimical: Conduct which is inimical to the health, morals, welfare or safety of either an individual in or receiving services from the facility or people of this state.

A copy of the amended report and appeal rights was discussed and provided to Michele Hazelwood, House Manager of The Refuge
SUPERVISOR'S NAME: Natasha DunlapTELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Nicole StricklandTELEPHONE: (951) 805-0220
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-CR-20220323132124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: REFUGE, THE
FACILITY NUMBER: 374603969
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2022
Section Cited
HSC
1550(c)
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***This is an amended document***
CONDUCT INIMICAL: Conduct which is inimical to the health, morals, welfare or safety of either an individual in or receiving services from the facility or people of this state.

This requirement is not met as evidenced by:
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Ex. Dir stated that Staff #1 (S1) is no longer with the facility. Ex. Dir stated that all staff will go through a vape pen training to include what vape pens look like the dangers of use. Ex. Dir stated that all staff will also go through a alcohol training. Ex. Dir will provide LPA with a copy of the outline for training and staff signatures by August 19, 2022 via email.
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Based on confidential interviews and record review the facility did not ensure Staff #1 (S1) fulfilled S1’s duty to ensure Child #1’s (C1s) health and safety when S1 purchased a vape pen and alcohol for C1 which posed an immediate Health, Safety or Personal Rights risk to children in care.
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Type A
ILS
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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.
SUPERVISOR'S NAME: Natasha DunlapTELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Nicole StricklandTELEPHONE: (951) 805-0220
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-CR-20220323132124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: REFUGE, THE
FACILITY NUMBER: 374603969
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2022
Section Cited
ILS
87072(c)(10)
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PERSONAL RIGHTS (c)(10) To be accorded dignity in their personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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Ex. Dir stated that Staff #1 (S1) is no longer with the facility. Ex. Dir stated that all staff had a personal rights training on July 15, 2022. Ex. Dir will provide LPA with a copy of the outline for training and staff signatures by August 19, 2022 via email.
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Based on confidential interviews and record review the facility did not ensure Child #1 (C1) was accorded dignity when Staff #1 (S1) made inappropriate comments to C1 which posed a potential Health, Safety or Personal Rights risk to children in care.
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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.
SUPERVISOR'S NAME: Natasha DunlapTELEPHONE: (951) 290-9741
LICENSING EVALUATOR NAME: Nicole StricklandTELEPHONE: (951) 805-0220
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4