374604330-7-24-2023-08-AS-IESA-CUA62G-20230731202532

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604330
Report Date: 07/24/2023
Date Signed: 07/24/2023 10:19:49 AM

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
12/15/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20221215130214

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: 26	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Administrator Shanta Haines		TIME COMPLETED:	10:25 AM

ALLEGATION(S):

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Lack of supervision, resulting in hospitalization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Shanta Haines.

The Department’s investigation consisted of interviews with clients, staff, and outside sources, records review, and a tour of the facility. It was alleged that lack of supervision resulted in client hospitalization. Interviews and records review revealed that on December 14, 2022, at around 1:30pm, facility program staff observed Client 1 (C1) to be unresponsive while seated in a chair. Staff contacted 911 emergency services and staff attempted to wake C1, who became responsive while waiting for paramedics. C1 was transported to the hospital where they received treatment for illicit substance use. C1 was discharged back to their residential facility the same day.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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-20221215130214

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: 07/24/2023

NARRATIVE

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Interviews and review of medical records revealed that C1 required line of sight supervision by staff at all times, had a history of illicit substance use, and there was at least one incident of elopement from C1’s residential facility to engage in illicit substance use. Interviews revealed that C1 preferred to not socialize with others while at the program and spent much of their time in the facility’s parking lot. Interviews revealed that facility staff were assigned to supervise clients while clients spent time in the facility parking lot. Interviews with staff assigned to supervise clients revealed that on December 14, 2022, C1 was under staff supervision while at the facility and there was no evidence that supported C1 leaving the facility property. Interviews revealed that the facility had security cameras that viewed the facility parking lot and review of the tapes did not reveal any instances of C1 speaking with anyone or leaving the facility property. Interviews with C1 did not reveal a consistent description of how C1 obtained the illicit substance or where C1 ingested the illicit substance. C1 denied that they obtained the illicit substance from facility staff or other clients and indicated that C1 purchased the illicit substance from an unidentified individual.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Administrator Shanta Haines, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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