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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604734
Report Date: 06/19/2024
Date Signed: 08/01/2024 04:34:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
04/10/2024 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20240410114321
FACILITY NAME:CHANGING OPTIONSFACILITY NUMBER:
374604734
ADMINISTRATOR:MELCHER, JENNIFERFACILITY TYPE:
735
ADDRESS:500 3RD STREETTELEPHONE:
(714) 224-0826
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:14CENSUS: 14DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Melcher, Jennifer, Administrator Day Treatment/Main HouseTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff not affording clients dignity
INVESTIGATION FINDINGS:
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On 6/19/2024, Licensing Program Analyst (LPA) Daniel Pena conducted a department-directed visit to the facility to further investigate the allegation in this complaint. After introducing and identifying himself, LPA met with Jennifer Melcher, Program Manager, and explained the nature of the allegation.

On April 10, 2024, the Community Care Licensing Division (CCLD) received a complaint which alleged staff did not accord a client with dignity.

The Department’s investigation consisted of facility inspections, review of client, staff, outside source and facility records, and interviews with clients, staff, and outside sources. LPA also reviewed the facility file and compliance history.

It was reported that the facility used punishment and "torture" in order to force a client to improve their hygiene. According to an outside source, a client transferred to the facility in late 2023. According to

**This is an amended document**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
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-20240410114321
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CHANGING OPTIONS
FACILITY NUMBER: 374604734
VISIT DATE: 06/19/2024
NARRATIVE
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interviews with staff and the client in question; the client admittedly had not showered in the three months before moving into the facility. A source reported that the facility made numerous attempts to motivate or encourage the client to shower unsuccessfully. Interviews with outside sources close to the client were conducted. These sources did not witness the facility treat the client without respect nor were they informed by the client that the client was forced to accept meals and medications outside.

According to interviews and record review, a previous employee sent staff an email asking them to encourage the client to take meals and medications outside the main common area. Interviews revealed staff understood the strategy to represent motivation for the client to shower. None of the staff interviewed stated they forced the client to shower nor accept meals outside. Clients were interviewed. None witnessed this client or any client receive medications or meals outside. Client interviews consistently stated that the client refused to shower and the client's odor was offensive. In none of the interviews with staff and clients, nor the records reviewed, did LPA locate a reference to torture or punishment of the client for refusing to practice hygiene.

Based on further investigation and follow up interview, it was determined on one occasion the client agreed to receive their medication at the door leading into the facility. The location is directly outside and adjacent to the medication room. The area is covered and based on interviews, the weather was not inclement or cold. The client was asked if staff forced them to get their medications or meals outside and they said they were not. This client said staff treats them ok but are "bossy" at times.

There is sufficient evidence to indicate that on one occasion, a client was given medication outside the facility due to poor hygiene. Although, there is no evidence the facility's intent was to torture or punish the client or strip them of their dignity, the Department considers even the consideration of such a practice to be a violation of the client's personal rights.

Based on interviews, a preponderance of evidence exists to show that the facility gave a client medication outside the facility on one occasion. The allegation is Substantiated. A deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Jennifer Melcher, to whom a copy of this report, the LIC 9099D, and Licensee/Appeal Rights (LIC9058 03/22) were provided.
**This is an amended document**
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
04/10/2024 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20240410114321

FACILITY NAME:CHANGING OPTIONSFACILITY NUMBER:
374604734
ADMINISTRATOR:MELCHER, JENNIFERFACILITY TYPE:
735
ADDRESS:500 3RD STREETTELEPHONE:
(714) 224-0826
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:14CENSUS: 14DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Melcher, Jennifer, Administrator Day Treatment/Main HouseTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility is inadequately staffed to manage client behavior
Facility is not addressing pest infestation
INVESTIGATION FINDINGS:
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It was also alleged, facility is inadequately staffed to manage client behavior and is not addressing a pest infestation.

On 6/19/2024, Licensing Program Analyst (LPA) Daniel Pena conducted a department-directed visit to the facility to reopen and further investigate the allegations in this complaint. After introducing and identifying himself, LPA met with Jennifer Melcher, Program Manager, and explained the nature of the allegations.

It was alleged that a client was urinating in their room and in the common areas. It was also alleged staff did not address other disruptive client behaviors. LPA visited the facility three times during this investigation. On none of the visits, did LPA smell urine throughout the facility. LPA interviewed said client and they indicated that they were working with staff to address this behavior. The client also said staff was providing them with undergarment supplies which LPA observed during the visits.

A source reported that a staff member asked a client to assist them during a verbal conflict with another client. The source stated the staff person should have asked another staff person for help instead of a client. Interviews with staff and management offered no corroboration that this incident took place. The
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20240410114321
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CHANGING OPTIONS
FACILITY NUMBER: 374604734
VISIT DATE: 06/19/2024
NARRATIVE
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alleged clients were contacted by LPA. The client involved in the alleged verbal dispute said one other client was present, and LPA tried to contact them. The client did not want to be interviewed. There is no record of the incident taking place that was made available during the investigation.

This complaint also alleged that the facility did not take steps to control a pest infestation. An outside source reported seeing mice in the kitchen. The source stated that they had not seen a professional pest control service treating the facility. The source stated that staff had trapped mice using glue traps. The source said the infestation is mice. This source does not believe the facility has a cockroach infestation as they originally reported. They said they only saw one roach. Based on interviews with clients, staff, and outside sources, no person reported evidence of a mice or roach infestation. All agreed that because the facility is located in a rural part of the county, mice are expected to be seen occasionally. None of the interviews indicated that the facility is infested. Facility staff provided LPA with professional pest control service reports which confirms the facility is taking action to ensure the mouse population is managed.

As to concerns of food quality, LPA conducted three unannounced visits to the facility and interviewed clients and staff. LPA observed the kitchen to be sanitary without evidence of dirt or debris. LPA observed food supplies and the freezers and refrigeration. LPA observed no evidence that food supplies were not fresh for consumption. LPA interviewed clients and staff. Only the source reported issues with the meals. During a brief period, a food service employee was out on medical leave. During that time, line staff pitched in cooking meals and ready-made meals were served. No client interviewed reported any problems with the food other than they would like more options.

Based upon the Department's investigation, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. No deficiencies were cited today.

An exit interview was conducted with Jennifer Melcher. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Ms. Melcher whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20240410114321
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CHANGING OPTIONS
FACILITY NUMBER: 374604734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2024
Section Cited
CCR
80072(a)(1)
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Personal Rights - To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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Licensee agreed to provide vendorized Personal Rights training to all staff including executive management. Contract for aforementioned training to be forwarded to CCLD by POC due date.
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Based on interviews, the facility did not accord Client 1 (C1) when having the client accept medication outside the common area. This posed a potential personal rights risk to one of fourteen (14) 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: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5