425802138-5-30-2023-29-AS-KBUY-CSCRAR-20230531125134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802138
Report Date: 05/30/2023
Date Signed: 05/30/2023 02:56:48 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
04/10/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230410082300

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:	03:10 PM

ALLEGATION(S):

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Clients are not being provided dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA interviewed reporting party on 4/14/23, requested relevant documents, interviewed Staff and clients on 4/19/23. LPA conducted the investigation with County Patient Rights Advocates (CPRA). LPA met with Clinical Director, Administrator, and Regional Director and explained the purpose of the visit.

On the allegation: Clients are not being provided dignity and respect. It was alleged that Client 1 (C1) was not being given dignity and respect by staff. It was reported Staff 1(S1) and Staff 2 (S2) drug test C1 for no reason, and if C1 doesn’t do the chores assigned to them, S1 and S2 threaten to call the police, and sometimes call C1 names. LPA interviewed clients who were currently enrolled in the Social Rehab Facility. C1 was no longer a client when LPA visited on 4/19/23, and C1 could not be located for interview. Clients interviewed stated staff treat clients well and all clients feel that they are treated with dignity and respect and staff never call them names. Continued on 9099-C

Substantiated

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)

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Control Number 29-AS-20230410082300

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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One client reported that S1 will take away smoke breaks for all clients if the smoking rules are not followed. This client feels that this is understandable because they believe rules are important and should be followed and will often tell staff when clients don’t follow the smoking rules, even though it means they will lose their smoke break. Other clients interviewed thought this rule was unfair and that only the client who breaks the rules should get their smoke break taken away. Interview with Staff 1 (S1) revealed that the previous administration made this rule and viewed smoking as an “earned privilege” and S1 didn’t like enforcing it, and didn’t feel it was fair. They admitted it was not fair to take away other’s smoke breaks and wasn’t aware they weren’t supposed to enforce it and agreed to stop enforcing it.

Clients interviewed were under the impression that if they didn’t complete their chores, perform their hygiene routine, or go to groups then they would not be able to go on their 2-4 break out into the community. Clients interviewed didn’t have a problem with this guideline and understood that this was a rehab program to get better and doing chores, ADLs, and attending group is a part of that. Staff interviewed stated that they don’t really enforce these guidelines and they know chores and groups aren’t mandatory. Staff stated they try to meet clients where they are at but incorporate these activities of daily living and the Community Pass Policy in order to build independent living skills.

Staff and Clients revealed that the policy for drug testing is a change in behavior. Clients stated they know they could be drug tested at any time. A few clients interviewed stated they had recently been drug tested and didn’t think it was unfair or for no reason. One client stated they have told staff on several occasions that certain clients should be tested based on their behavior. Staff interviewed revealed they will test clients if they come back from the 2pm-4pm community time acting or behaving strange or different and possibly be under the influence. One staff interviewed stated C1 was tested multiple times due to strange behavior. Staff mentioned one day C1 moved all the furniture around so they tested C1 for possible substances and it wasn’t without reason or to single C1 out.

Management stated they counseled S1 multiple times on the correct way to speak to and treat clients. They stated S1 struggled with manic clients that didn’t calm down easily and were very symptomatic. Management indicated S1 liked to nitpick and be punitive, and give “consequences” for not following the rules. Management stated S1 admitted to threaten to call the cops on multiple occasions and would belittle clients. Staff 1 was put on administrative leave on 4/19/23 based on the facility’s internal investigation and stated the allegations were found to be substantiated. Continued on 9099-C

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)

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Control Number 29-AS-20230410082300

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	Based on the information obtained, the allegation Clients are not being provided dignity and respect, is Substantiated at this time. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted, copy of report and appeal rights were printed and emailed.

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

Control Number 29-AS-20230410082300

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/30/2023 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	80072(a)(3) Personal Rights (a) ...each client shall have personal rights...(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator scheduled a personal rights training for all staff on 6/15/23. Administrator agreed to send training records with name, date, time and signature to CCL once complete.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above when Staff 1 (S1) threatened to call the police on C1 for not doing their chores and took away smoke breaks for all clients, which posed an immediate personal rights risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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