374604330-2-10-2023-08-AS-LTEZ-CPGU23-20230228141115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604330
Report Date: 02/10/2023
Date Signed: 02/10/2023 03:49:38 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
11/21/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20221121164010

FACILITY NAME:	AMARIS CENTER FOR CHANGE		FACILITY NUMBER:	374604330
ADMINISTRATOR:	GASQUE, RUKHSANA		FACILITY TYPE:	775
ADDRESS:	250 E DOUGLAS AVE		TELEPHONE:	(202) 520-3781
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	40	CENSUS: 29	DATE:	02/10/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Staff, Travis Moore		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Neglect/Lack of supervision resulting in client altercation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud concluded the complaint investigation regarding the above mentioned allegation. LPA met with Staff, Travis Moore.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, clients, and outside sources. It was reported, Neglect/Lack of supervision resulted in client altercation between Client #1 (C1) and Client #2 (C2). On 11/18/22, the Day Program transportation van was getting ready to take the clients home, when the incident occurred. Everyone was seated in their seat, even staff, as they were getting ready to transport everyone home. The clients entered the bus and sat in their assigned seats. C1 made a comment that C2 did not like, which resulted in C2 hitting C1 in the back of the head, as C2 was seated directly behind C1. Staff interviews confirmed C1 said something that C2 didn’t like and C2 hit C1, but staff intervened. Staff had C1 exit the van and C2 remain on the van for their safety, while the situation was being deescalated. Both clients were provided separate transportation to their own homes. Staff’s interview explained the two clients are close and get along well, this was their first physical altercation. However, due to both of the client’s medical diagnoses, they have behaviors at times that can result in verbal altercations, but not physical.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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-20221121164010

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: 02/10/2023

NARRATIVE

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C2’s interview confirmed C1 made an unwanted comment, so C2 hit C1 on the back of the head. C1’s Individual Support Plan, dated 07/18/22 indicated C1 has verbal outbursts. C2’s Individual Program Plan dated 10/27/21 indicated C2 has history of physical aggression. However, this is the first time C1 and C2 had a physical altercation. An outside source’s interview revealed C2 has aggression and will hit staff and other clients in their living facility. Outside source interviews confirmed C2’s aggression happens quickly, even with staff present for supervision. Additional interviews with outside sources confirmed the day program staff supervises the clients. All involved with C2 are aware of the behaviors and are working with C2 to reduce their aggression. Staff provided supervision by intervening in the altercation, no injuries were observed on either client. Staff confirmed they supervise the clients. C2 is no longer a participant at this day program.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Staff, Travis Moore whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Client #1 and Client #2]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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