374604330-9-8-2023-08-AS-DNGN-CVGR5K-20230908124317

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604330
Report Date: 09/08/2023
Date Signed: 09/08/2023 12:44:24 PM

Document Has Been Signed on 09/08/2023 12:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 35	DATE:	09/08/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Administrator Shanta Haines and Licensee Rukhsana "Roxy" Gasque		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Shanta Haines. LPA also met with Licensee Rukhsana "Roxy" Gasque, who arrived later during the visit.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 04/10/2023). According to the LIC624: On 04/03/2023, Staff #1 (S1) and Staff #2 (S2) took Client #1 (C1), Client #2 (C2), Client #3 (C3), and Client #4 (C4) to a casino. [See LIC 811 Confidential Names List for a description of person identifiers used in this report]. While at the casino, S1 and S2 did not provide needed supervision to clients.

During today’s visit, LPA briefly toured the day program facility and performed a welfare check on the client participants, finding no immediate safety concerns. LPA also reviewed pertinent care and administrative records and interviewed relevant staff.

According to C1’s LIC602 Physician’s Report, they were diagnosed with “Developmental Delay” and “Epilepsy,” and their doctor determined that C1 required staff supervision when in the outside community for their safety. According to C2’s LIC602 Physician’s Report (dated 02/09/2023), they were diagnosed with “Mild Intellectual Disability” and “Epilepsy,” and their doctor determined that C2 required staff supervision when in the outside community for their safety. According to C3’s LIC602 Physician’s Report (dated 02/24/2023), they were diagnosed with “Mild Intellectual Disability” and “Autism,” and their doctor determined that C3 required staff supervision when in the outside community for their safety. According to C4’s LIC602 Physician’s Report (dated 08/23/2022), they were diagnosed with “Schizophrenia,” “Bi-polar Disorder,” and “Mental Retardation,” but their doctor determined that C4 could safely self-manage themselves in the outside community.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/08/2023

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[CONTINUED FROM LIC 809]

According to the Admissions Agreement signed by each client, and corroborated by Licensee interview: The day program’s “service-learning curriculum” is focused on helping clients be “active citizens” and “integral members of our community.” The “services offered” consist of “vocational skills training (job sampling and shadowing), service learning, life skills training, self-determination, decision making, communication, etc.” The day program enables clients to work/volunteer in the community to build skills, for which clients earn a monetary compensation or stipend.

Interviews and records showed: On 04/03/2023, S1 and S2 helped C1, C2, C3, and C4 board the facility’s van. Once aboard, S1 and S2 announced they were taking these clients to the casino, instead of the clients’ respective work sites. S1 and S2 did not give the clients a choice to decline / not participate. The group was at the casino for around two (2) hours; S1 and S2 turned their backs to the clients as they gambled on slot machines. C3 was known to be easily distracted by stimuli and had a history of wandering away from staff; C3 indeed momentarily paced away from S1 and S2 during the incident. S1 and S2 also told the clients to lie/conceal that they had gone to the casino, telling them that if they told the truth about where they went, the clients would not receive their daily monetary stipend.

Interviews and personnel records further showed: Licensee gained constructive knowledge of the incident on 04/04/2023 and immediately suspended S1 and S2 pending internal investigation. Licensee subsequently terminated S1's and S2’s employment, citing that during the incident S1 and S2 “violated clients’ rights” and left clients unsupervised while they gambled.

CCLD concluded that a preponderance of evidence exists to show that during the above incident: a) Licensee’s staff (S1 and S2) did not provide needed observation to C1, C2, and C3 (who required supervision); and b) Licensee’s staff (S1 and S2) tried to coerce C1, C2, C3, and C4 to lie / conceal information. Two (2) deficiencies were cited per California Code of Regulations, Title 22 (see attached LIC809-D). Plans of Correction were jointly developed with the licensee.

An exit interview was conducted with Haines, to whom a copy of this report, the LIC809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/08/2023 12:44 PM - It Cannot Be Edited

Created By: Dang Nguyen On 09/08/2023 at 12:22 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: AMARIS CENTER FOR CHANGE	FACILITY NUMBER: 374604330
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/08/2023 Section Cited CCR 82078(a)	1 2 3 4 5 6 7	82078 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 admissions agreement.” This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	Per personnel records and licensee interview: S1 and S2 were terminated from employment on 04/10/2023. Licensee agreed to retrain all remaining direct care staff on the day program's mission objectives, and licensee's expectations regarding staff attentiveness and line-of-sight supervision of clients (for those who require it per their LIC624 Physician’s Reports and/or SDRC care documents), whenever those clients are out in the community. Licensee agreed to E-mail LPA a copy of the training sign in sheet, by the POC due date.
	8 9 10 11 12 13 14	Based on records and interviews: During the incident in question, Licensee’s staff (S1 and S2) did not provide care and supervision necessary to meet client needs and all services specified in the admissions agreement for 3 of 35 clients (C1 through C3), which posed a potential safety risk to persons in care.	8 9 10 11 12 13 14
Type B 10/08/2023 Section Cited CCR82072(a)	1 2 3 4 5 6 7	82072 Personal Rights: “(a) Each client shall have personal rights which include…the following: (3) To be free from…coercion, threat…” This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	Per personnel records and licensee interview: S1 and S2 were terminated from employment on 04/10/2023. Licensee agreed to retrain all remaining direct care staff on Client Personal Rights (as articulated in CCLD form LIC613 and DDS form DSP304). Licensee agreed to E-mail LPA a copy of the training sign in sheet, by the POC due date.
	8 9 10 11 12 13 14	Based on records and interviews: During the incident in question, Licensee’s staff (S1 and S2) did not ensure that 4 of 35 clients (C1 through C4) were free from coercion, which posed a potential personal rights risk to persons in care.	8 9 10 11 12 13 14

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:

Lizzette Tellez

LICENSING EVALUATOR NAME:

Dang Nguyen

LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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