425802138-5-30-2023-29-AS-KBUY-CSCRD5-20230531125523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802138
Report Date: 05/30/2023
Date Signed: 05/30/2023 02:48:01 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, 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
02/13/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230213084818

FACILITY NAME:	TELECARE AGNES AVENUE		FACILITY NUMBER:	425802138
ADMINISTRATOR:	CESAR ARGUETA		FACILITY TYPE:	772
ADDRESS:	116 AGNES AVENUE		TELEPHONE:	(805) 457-3724
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	10	CENSUS: 7	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Hanna Diaz, Clinical Director, Alex Briceno, Administrator, and Cindy Doutt, Regional Director		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff member sexually abused resident in care.
Staff did not safeguard resident's belongings.
Staff did not provide a safe environment for resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver findings for the above allegations. LPA met with Clinical Director, Administrator, and Regional Director and explained the reason for the visit.

On 02/13/2023, the Department received a complaint regarding the allegations: Staff member sexually abused resident in care, Staff did not safeguard resident's belongings, and Staff did not provide a safe environment for resident in care.
On 02/14/2023, from 12:40pm to 6:15pm, Licensing Program Analysts (LPAs) Jenny Olson and Brian Phillips conducted the initial complaint visit to the facility above. LPAs Olson and Phillips met with Clinical Director, and explained the purpose of the visit. Previous Administrator arrived around 1:30pm. The LPAs requested documents relevant to the investigation and informed that one allegation was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Santiago. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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-20230213084818

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: TELECARE AGNES AVENUE	FACILITY NUMBER: 425802138
	VISIT DATE: 05/30/2023

NARRATIVE

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LPA Olson investigated the remaining allegations, obtained documentation, and interviewed staff and clients on 4/19/23.

On the allegation: Staff member sexually abused resident in care. It was alleged that Staff #1 (S1) made sexual advances toward Client #1 (C1). On 02/24/2023, at approximately 4:11pm, Investigator Santiago conducted an interview with the reporting party (RP); on 03/16/2023, from approximately 11:00am to 4:10pm, attempted interview with former Client #1 (C1), staff, clients, and Regional Director of Operations; on 03/17/2023, from approximately 9:00am to 11:15am, attempted interview with C1, staff, Clinical Director, and attempted interview with Staff #1 (S1); on 04/11/2023, from approximately 9:30am to 9:54am, left voicemail message for C1 and S1; on 04/17/2023, at approximately 8:30am, attempted interview with S1; on 04/28/2023, at approximately 8:00am, attempted interview with S1; on 05/01/2023, from approximately 10:30am to 1:55pm, with C1, Regional Director of Operations, and attempted interview with a former client who declined to be interviewed; on 05/05/2023, from approximately 9:15am to 9:45am, with Employee Relations Manager and S1. Additionally, Investigator Santiago reviewed facility file documents, text messages, and Santa Maria Police Department Report #SMPD23009523 relevant to the complaint.

According to the Physician Report, dated 08/29/2022, C1’s diagnosis included Major Depressive disorder, severe without psychotic feature. C1 was able to follow instructions, occasionally confused but able to communicate needs. A review of C1’s chart and admit notes revealed issues between C1 and clients, but the notes had no revelation of the relationship between C1 and S1. C1 was admitted to the facility on 07/15/2022, discharged 08/18/2022, and admitted again on 08/30/2022, discharged 09/29/2022.

Information obtained from Investigator Santiago’s interviews revealed C1 denied that they were sexually abused by S1 and stated that S1 “never” forced anything on them. C1 also denied that S1 inappropriately touched C1 or conducted an unwelcomed behavior. However, C1 indicated that they shared a kiss in S1’s office which was consensual on both parties. There were no witnesses to corroborate that the kiss happened between C1 and S1. C1 admitted that they never disclosed to any staff about sexual abuse by S1. None of the clients or staff have expressed concern or speculated that C1 and S1 had any form of relationship. S1 did not have a history of sexual abuse in their file, nor have any staff or clients expressed concerns about S1’s behavior. All the staff that were interviewed did not disclose that they saw any signs or indicators that there was a sexual relationship between C1 and S1. Client interviews also did not reveal that they were victims of sexual abuse by S1. Continued on 9099-C (pg 3)

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230213084818

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: TELECARE AGNES AVENUE	FACILITY NUMBER: 425802138
	VISIT DATE: 05/30/2023

NARRATIVE

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There were explicit text messages that were alleged to be between C1 and S1, but the contact information listed under S1’s name did not reveal a link to S1’s current or history of contact information via the Law Enforcement Database. S1 denied that the text messages were from S1 and refuted the claim that they had a sexual relationship or any form of relationship with C1 in or outside of the facility. Therefore, based on interviews and evidence obtained from the investigation, there was not a preponderance of evidence to suggest that the alleged sexual abuse occurred. The allegation “Staff member sexually abused resident in care” is deemed Unsubstantiated at this time.

On the allegation: Staff did not safeguard resident's belongings. It was alleged that after C1 went to a new facility they noticed several of their belongings were missing (perfume, headphones, other items) and feels either the staff or another resident(s) at this facility took them. Interviews with staff and clients revealed upon admission, staff record all items clients bring in. Clients are given a key to a box where they can store items in their room as well as a locker key to store other larger items in the common area lockers. If clients come with a lot of items they are asked to store the extra items in a locked cabinet or outside shed. Interviews revealed some clients are unhoused and come to the facility with a cart full of their possessions and sometimes it’s too much to store in the lockers. Staff interviewed stated they document the items and where they are stored to ensure clients get them back when they discharge. Clients interviewed stated they have not had any issues with items going missing and feel that their items are safe at the facility. Based on the information obtained, the allegation “Staff did not safeguard resident’s belongings” is deemed Unsubstantiated at this time.

On the allegation: Staff did not provide a safe environment for resident in care. It was alleged that a few days after C1 moved in another client pinched their rear end and harassed C1. C1 stated that staff were present and didn’t do anything. C1 stated the client chased C1 with scissors and the police were called. LPA reviewed the incident report dated 9/7/2022 that stated Client 2 (C2) came up behind C1 while waiting for medication and C2 pinched C1’s bottom, which made C1 uncomfortable. LPA reviewed another incident report dated 9/15/2022 where Client 3 (C3) “stormed” out of the office and ran towards C1’s room. C1 met C3 in the hallway, would not let C1 pass, and stated to C1 “I will kill you b---- let’s go outside.” The incident report states C3 continued to verbally assault C1 throughout the day. Incident report indicates staff called the administrator, local police, and the mobile crisis unit for C3, and C3 was taken away on a 5150 hold. LPA interviewed multiple clients who stated they felt safe at the facility and staff do a good job providing a safe environment. Continued on 9099-C (pg 4)

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 29-AS-20230213084818

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: TELECARE AGNES AVENUE	FACILITY NUMBER: 425802138
	VISIT DATE: 05/30/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Staff interviewed stated they keep clients safe by doing rounds every 15-30 minutes, keeping an eye on clients, supporting them, and mediate conflicts. Based on the information obtained, the allegation “Staff did not provide a safe environment for resident in care” is deemed Unsubstantiated at this time. Exit interview, copy of report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4