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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604330
Report Date: 10/03/2022
Date Signed: 10/05/2022 01:34:00 PM

Substantiated


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
07/12/2022 and conducted by Evaluator Vicky Williamson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220712161124
FACILITY NAME:AMARIS CENTER FOR CHANGEFACILITY NUMBER:
374604330
ADMINISTRATOR:GASQUE, RUKHSANAFACILITY TYPE:
775
ADDRESS:250 E DOUGLAS AVETELEPHONE:
(202) 520-3781
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:40CENSUS: 30DATE:
10/03/2022
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Joseph Baker, Assistant Program DirectorTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Lack of supervision resulting in AWOL
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vicky Williamson conducted a complaint visit to deliver findings on the above allegation. LPA was greeted and allowed entry into the facility by Joseph Baker, Assistant Program Director (APD), to whom LPA discussed the purpose of the visit.

The Department’s investigation consisted of interviews with staff, a client, and outside sources. A review of records to include client records.

It was alleged that there was a lack of supervision resulting in an AWOL. It was reported that on 7/11/22, Client (C1) went AWOL from the facility due to being unsupervised by staff. Interviews conducted with staff and outside sources revealed that C1 refused to get on the transportation van at around 2:00 pm to be transported to the facility where they reside. Joseph Baker, Assistant Program Director (APD) contacted Staff 1 (S1) from C1’s primary residence and advised them that C1 refused to ride the transportation van from the day program to their residence.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
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 5
Control Number 08-AS-20220712161124
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: AMARIS CENTER FOR CHANGE
FACILITY NUMBER: 374604330
VISIT DATE: 10/03/2022
NARRATIVE
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S1 was advised that C1 would need to be picked up from their day program. S1 advised APD that they were currently not available to pick up C1, however they would pick C1 up at 4:30 pm. APD agreed that it would be ok to pick up C1 at 4:30 pm.

APD advised C1 that staff from their primary residence would be picking them up soon. C1 left the premises and walked to the parking lot area next to the facility. Per APD, C1 was within in eyesight the entire time and was asked multiple times to return to the facility. APD had to go inside of the facility due to a personal emergency and upon returning observed that C1 was no longer in view. Per APD, he assumed that C1 was picked up by S1.

Interviews with staff and outside sources revealed that S1 arrived at the facility between 4:50 pm and 5:00 pm to pick up C1. Upon the arrival of S1 to the facility, it was observed that C1 was not at the facility. It was assumed by APD that C1 had already left the facility with S1.

Interviews with APD, S1, and an outside sources revealed that the El Cajon Police Department was contacted and a missing report was filed for C1. Per ECPD, C1 was reported missing; however there was not a report created. An outside source contacted the ECPD within 15 minutes after the initial missing report was filed to advise the department that C1 had been located. C1 was located by S1 at the park less than one block from the facility at approximately 5:20 pm; C1 was observed to be safe.

An Interview conducted with C1 revealed that when the facility staff at the day program and the staff where they reside do not allow them to do the things they want to do; they are going to continue to AWOL. C1 disclosed that they were tired of waiting and was ready to leave the the day program on the day in question. A review of C1’s records determined that C1 is not allowed to leave the facility alone and without supervision.

The Department has investigated the above-mentioned allegation that a lack of supervision resulted in AWOL. Based on interviews conducted with licensee, assistant program director, staff, a client, outside sources and record review, the preponderance of the evidence standard has been met. Therefore, the allegation is deemed substantiated.



The deficiency is noted on the attached LIC9099-D and is cited in accordance with the California Code of Regulations, Title 22, Division 6. A copy of this report along with Licensee/Appeal Rights (LIC 9058) was provided to Joseph Baker, Assistant Program Director and the signature on this form confirms receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20220712161124
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: AMARIS CENTER FOR CHANGE
FACILITY NUMBER: 374604330
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2022
Section Cited
CCR
82078(a)
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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement. This requirement was not met as evidenced by: Based on interviews conducted with licensee, assistant program
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Assistant Program Director will cmplete a training with an outside source for staff and submit proof of training by POC date.
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director, staff, client, outside sources, and review of client records. Assistant Program Director left C1 alone and without supervision resulting in the absence without leave (AWOL) of C1 from the facility on 7/11/22. This poses an immediate health and safety risk to clients 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.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5