374604208-9-22-2023-08-AS-LTEZ-CW5T4A-20230929142336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604208
Report Date: 09/22/2023
Date Signed: 09/22/2023 02:23:35 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
06/04/2020 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20200604213616

FACILITY NAME:	LIBERTY TRANQUILITY		FACILITY NUMBER:	374604208
ADMINISTRATOR:	BLACKSHEAR, SHAWN		FACILITY TYPE:	737
ADDRESS:	1404 ASH STREET		TELEPHONE:	(760) 654-6277
CITY:	RAMONA	STATE: CA	ZIP CODE:	92065
CAPACITY:	4	CENSUS: 4	DATE:	09/22/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Morgan Davis, Director of Quality Assurance and Training		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Facility staff verbally humiliated client.

Facility staff did not safeguard client resources.

Facility staff falsified facility records.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Morgan Davis, Director of Quality Assurance and Training, to whom she disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above-listed complaint allegations. The investigation consisted of a tour of the facility, review of facility records, and interviews of staff.

It was alleged that staff verbally humiliated a client in care. It was reported to Community Care Licensing that staff told a client, “In order for you to go [on the outing], you need to take a shower, because you smell like piss.” It was also reported that the client was called “lazy ass” after an episode of urinary incontinence. Interviews conducted during the investigation did not yield corroborating evidence to conclude that either the statement or derogatory term was made to or in the presence of the client.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023

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-20200604213616

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: LIBERTY TRANQUILITY	FACILITY NUMBER: 374604208
	VISIT DATE: 09/22/2023

NARRATIVE

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The second allegation is that client funds were not safeguarded. It was reported that a client reported having $6.96 missing and, subsequently, reported that $10.00 of funds were missing. It was also reported that the facility’s program director kept a Ziploc bag in which any lost-and-found money was stored, and the program director instructed staff to use funds from the lost and found money to replace missing client funds. The investigation yielded that, at the time, the program director solely managed client Personal & Incidental funds and distributed any funds for client use to the staff who would be responsible for safeguarding those funds while on client outings. The investigation also yielded that staff were responsible for providing receipts for expenditures incurred, along with any remaining funds, upon return. The investigation did not yield evidence to conclude that client funds were missing, not properly accounted for, or not safeguarded.

The third allegation is that facility staff falsified facility records. It was reported that client medication was not administered because it was accidentally left at the facility when the client was transported to the hospital on May 2, 2020. It was also reported that once the program director was made aware that the medication was left at the facility, the program director disposed of the medication and instructed staff to record that the medication had been administered to the client. A review of records maintained by the facility reflected that the medication count of dosages distributed and entrusted to staff were verified, signed, and accounted for upon release for departure, and the number of dosages/medications returned to the facility following the hospital visit were verified and accounted for as well. The investigation did not yield evidence to corroborate the allegation that staff falsified records to reflect that medications were administered when they were not.

Based upon the foregoing which reflects a lack of evidence to corroborate the allegations, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, the investigation did not produce a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Morgan Davis, and copies of this report and Licensee Rights were provided to Morgan at the conclusion of the visit. Her signature on this report acknowledges receipt of copies of the report and the rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023

LIC9099 (FAS) - (06/04)

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