374604188-7-27-2023-08-AS-DPOL-CU9R86-20230731124721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604188
Report Date: 07/27/2023
Date Signed: 07/27/2023 10:46:11 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
02/16/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230216094949

FACILITY NAME:	R&A HOMES		FACILITY NUMBER:	374604188
ADMINISTRATOR:	SAMS, ROSE		FACILITY TYPE:	735
ADDRESS:	1670 BAKERSFIELD ST		TELEPHONE:	(619) 962-8009
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	4	CENSUS: 4	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Fred Sams, Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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- Licensee did not meet client's care needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced visit to deliver complaint findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Fred Sams, Administrator. LPA stated the purpose of the visit and reviewed the findings of the complaint with Administrator's and Licenee Sams'. Licensee Rose Sams and Administrator Leilani Sams later arrived and joined the visit.

The Department’s investigation consisted of interviews with staff and outside sources, and records review of relevant documents pertinent to this investigation. On February 16, 2023, it was alleged that the facility administrator was not able to meet a client’s care needs.

It was specifically alleged that on February 08, 2023, the administrator was not able to de-escalate client #1 (C1’s) behavior resulting in the local law enforcement having to call for C1 to be transported to the hospital for a psychiatric evaluation. Interviews with outside sources were consistent and said that at around 9:30 am, C1 became aggressive towards staff at their Day Program (DP). The situation resulted in the DP contacting C1’s facility for assistance as the client was not cooperating with DP staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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-20230216094949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: R&A HOMES	FACILITY NUMBER: 374604188
	VISIT DATE: 07/27/2023

NARRATIVE

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According to outside sources, the facility staff attempted to de-escalate the situation by communicating with C1’s family to no avail. After the facility staff’s communication with the family, they were required to contact law enforcement for further assistance. Two responding Officers arrived at the scene. According to outside sources, C1 was agitated and said that they wanted to hurt themselves. Facility Administrator spoke with the officers, but who were reluctant to assist with C1, and did not want to call in an involuntary psychiatric hold. Law enforcement directed the Facility Administrator to pick-up C1 from the DP or have the client medically transported. Facility staff attempted to arrange transport but was unable to due to lack of insurance coverage. The facility administrator drove to the DP but did not want to transport C1 due to safety concerns about C1’s aggressive behavior. According to Facility Administrator, they attempted to contact various medical transport services to assist, but none would cover those services. According to outside sources, law enforcement was contacted four times for assistance, but officers were reluctant to assist. According to the Administrator, they requested for a Psychiatric Emergency Response Team (PERT) but instead the same responding officers arrived, and said they were PERT certified. At approximately 3:00 PM law enforcement contacted an ambulance. Interview with outside service agency corroborated all the administrator’s statements.

A review of records revealed that the incident transpired on 2/08/23, C1 was having a behavior and 911 was initiated. Upon law enforcement arrival, C1 attempted to hit a police officer and stated their intent of self-injurious behavior. C1 continued the behavior until approximately 3:00 pm when an ambulance arrived. Additional records revealed that 911 transcript showed a recurring call at 1:47 pm with multiple units responding for C1 hitting staff and other clients. It described that C1 was threatening to hurt themself and others. According to reports, C1 had been on a psychiatric hold two weeks prior and was having random outbursts but did not pose a threat and was not able to cause physical harm. According to records, the facility administrator requested assistance with transport which was refused. C1 hit the administrator several times and so staff contacted 911 again and requested for a PERT team but the same responding officers arrived. The final time the officers responded, it was determined that the client needed to be treated and an ambulance was contacted. According to C1’s Placement Referral information, C1 had behaviors of aggression towards self, others, and property. There were documented episodes of physical aggression, property destruction, suicidal and homicidal ideations (SI/HI), and threats to others.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and outside source interviews, and records reviewed, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be unsubstantiated.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230216094949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: R&A HOMES	FACILITY NUMBER: 374604188
	VISIT DATE: 07/27/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	The report was discussed, and an exit interview was conducted with Administrators and Licensee Sams' . A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Administrator/Licensee Sams' at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

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