405801561-4-14-2023-29-AS-KBUY-CRA2LN-20230426172948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405801561
Report Date: 04/12/2023
Date Signed: 04/14/2023 04:18:11 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/05/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20221005122220

FACILITY NAME:	TRAFFIC WAY HOUSE		FACILITY NUMBER:	405801561
ADMINISTRATOR:	DEBBIE STARLING		FACILITY TYPE:	735
ADDRESS:	5000 TRAFFIC WAY		TELEPHONE:	(805) 466-0721
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	14	CENSUS:	DATE:	04/12/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Debbie Starling, Licensee/Administrator		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Due to a lack of care and supervision, resident was sexually assaulted by another resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Chavez conducted a subsequent complaint visit to deliver final findings for the above allegation. The initial complaint visit was conducted on 10/06/2022 by LPA Chavez. During today’s visit, LPA met with Debbie Starling, Licensee/Administrator, and explained the reason for the visit. Also in attendance was Miguel Magana, Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS).

On 10/05/2022, the Department received a complaint regarding an allegation of “Due to a lack of care and supervision, resident was sexually assaulted by another resident in care.” It was alleged that Client #1 (C1) was sexually assaulted by Client #2 (C2) in the facility prior to 10/03/2022. Both C1 and C2 reside in the facility.

Continued on 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

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 4

Control Number 29-AS-20221005122220

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRAFFIC WAY HOUSE	FACILITY NUMBER: 405801561
	VISIT DATE: 04/12/2023

NARRATIVE

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On 10/05/2022, the Department referred the complaint to the Community Care Licensing Investigations Branch (IB) and Special Investigator Romelia Munoz was assigned to conduct the investigation in reference to the allegation of lack of supervision resulting in the client being sexually assaulted while in care.

On 10/06/2022, between 12:09 pm and 1:50 pm, LPA Chavez conducted an unannounced 24-hour complaint visit. LPA met with Debbie Starling, Licensee/Administrator, and informed her of the reason for the visit. Also, in attendance was the TCRC QAS. During the visit, the LPA interviewed the administrator and requested the following documentation: Incident Report, Identification and Emergency Information sheets, conservatorship documents, annual report, staff notes and staff schedule. The administrator was notified that the case was referred to Community Care Licensing Investigation's Branch (IB) Special Investigator Romelia Munoz for further investigation.

Investigator Munoz conducted interviews on 11/22/2022, at approximately 9:45 am, with facility staff; on 11/22/2022, at approximately 10:55 am, with C1; on 11/14/2022, between approximately 10:25 am and 12:30 pm, with C1, C2, and staff; on 11/16/2022, at approximately 10:30 am, with the administrator; on 12/27/2022, at approximately 11:45 am with a Witness #1 (W1); on 12/28/22 between approximately 12:00 pm and 2:15 pm with the administrator and Witness #2 (W2). Additionally, the Investigator reviewed copies of Atascadero Police Department’s police report and supplemental report, Notes from Day Program Director and facility documents related to C1.

The investigation revealed that on 10/03/2022, Client #1 (C1) reported to Staff #1 (S1) and the administrator that C2 had sex with C1 against C1’s will. C1 could not say the exact date this happened but says that C2 came into C1’s room while C1 was asleep at night, C2 pulled down C2’s pants and C2 put C2’s penis in C1’s vagina. C1 says that they told C2 “no” before C2 sexually assaulted C1. Staff #2 (S2) was the sole staff on-duty during the late evening to morning shift and did not witness the event due to being asleep in their room. C2 denies the allegation, however, C2 informs of an incident that occurred at the facility where C2 was left alone with C1 while staff were asleep. C2 describes that C1 slipped in the shower and fell and was partially dressed. C2 went into the restroom to assist C1 and took C1 back to C1’s bedroom. Administrator says staff did not respond to the fall incident because everyone is ambulatory and “C1 could have called with their cellphone.”

Continued on 9099-C.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20221005122220

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRAFFIC WAY HOUSE	FACILITY NUMBER: 405801561
	VISIT DATE: 04/12/2023

NARRATIVE

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On 10/9/2018, facility staff walked in on C2 and Client #3 (C3) laying side by side on C2’s bed and they appeared to be kissing. On 3/17/20, day program staff reported to the facility that C2 exposed C2’s penis to another Client #4 (C4), who was C2’s girlfriend at the time. On 4/26/22, day program staff reported to the facility that C2 touched C4’s breast, who was C2’s girlfriend at the time. On 2/7/2023, C2 followed Client #5 (C5) into the women’s restroom at a pizza restaurant and tried to lick C5’s face. The day program staff counseled C2 that these were inappropriate behaviors, and informed licensee/administrator of Traffic Way about the incidents.

C2 has a pattern of sexually inappropriate behavior. Facility staff did not reassess C2 after the inappropriate incidents and did not take any extra precautions or provide additional supervision to C2, including no awake overnight staff in the facility following these incidents. Facility staff and day program staff had a meeting in March or April 2022 to discuss C2’s behavior and these incidents, but again no changes were made in C2’s needs and services plan or to the care and supervision the facility provided C2.

Based on the statements provided and documentation obtained, the Department has sufficient evidence to support the allegation “Due to a lack of care and supervision, resident was sexually assaulted by another resident in care.” Therefore, the allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D).

Exit interview conducted, deficiency cited, and the report and appeal rights given to the licensee.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20221005122220

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRAFFIC WAY HOUSE	FACILITY NUMBER: 405801561
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/13/2023 Section Cited CCR 80078(a)	1 2 3 4 5 6 7	80078(a) Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee has already talked with staff about the situation and also commits to provide training on Personal Rights for Residents, Sexual Harassment, and Abuse Prevention. Licensee has identified two staff who can work the NOC shift. Licensee will work on obtaining funding from TCRC for awake night shift staff and will start this process immediately. Licensee will send CCL a commitment by 4/13/23 that the training and process for funding will be completed by 4/19/23.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee failed to ensure proper supervision of residents in care resulting in C2 sexually assaulting C1, which posed an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
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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: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC9099 (FAS) - (06/04)

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