425850084-7-18-2022-29-AS-KBUY-CGL2K9-20220722172735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850084
Report Date: 07/18/2022
Date Signed: 07/18/2022 04:27:33 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
06/03/2022 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20220603151816

FACILITY NAME:	DEVEREUX CALIFORNIA - TULAROSA		FACILITY NUMBER:	425850084
ADMINISTRATOR:	PATTON, CHRISTOPHER		FACILITY TYPE:	737
ADDRESS:	1855 TULAROSA ROAD		TELEPHONE:	(805) 879-0357
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	3	CENSUS: 1	DATE:	07/18/2022
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Chris Patton, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility retained a resident with a higher level of care needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings. LPA requested documents and interviewed staff on 6/09/2022.

On the allegation: Facility retained a resident with a higher level of care needs. Reporting Party (RP) stated they are concerned with the facilities ability to care for Resident 1 (R1’s) needs. RP believes that R1 is not receiving the medical care needed for an Auto Immune Disease (PANDAS) Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. RP states the facility is treating R1’s behavior as a psychological issue when they believe it needs to be treated medically. RP was also concerned about the facility’s ability to protect R1 from injuring their functioning eye while in care.

LPA interviews revealed that Tri-Counties Regional Center (TCRC) is the placement agency for R1, and was involved in placing R1 in this facility. R1 also has a Conservator. R1’s Conservator and R1’s Case Manager at TCRC have determined that the facility is an appropriate placement for R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022

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-20220603151816

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: DEVEREUX CALIFORNIA - TULAROSA	FACILITY NUMBER: 425850084
	VISIT DATE: 07/18/2022

NARRATIVE

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R1 is in the highest level facility licensed by Community Care Licensing. Interviews also revealed that R1 has a care team of over 10 professionals that meet monthly to ensure R1 is on track and R1’s goals and needs are being met. The care team includes a Board Certified Behavior Analyst (BCBA), a Quality Behavior Modification Professional (QBMP), Assistant Supervisor, Program Administrator, and a Program Coordinator. LPA interviewed the facility’s BCBA, who also stated that R1 is in the proper placement. BCBA stated R1 has all the support they need including a Staff in charge (SIC) in addition to 2 staff who are with R1 at all times. R1’s Primary Care Physician (PCP)’s nurse is present at the facility every week for 10 hours, and is also contacted if any medical issues arise. The nurse communicates with R1’s PCP doctor who sees R1 in-person once a month. Administrator interview revealed that staff training is very comprehensive, and staff constantly monitor R1 to ensure R1’s care plan is being followed. This care plan helps ensure R1 is meeting monthly goals and all of R1’s needs are being met.

Interviews revealed in May 2022, TCRC met with R1’s family members and agreed to see a new doctor for a second opinion on R1’s diagnosis. LPA reviewed documents that showed the last time R1 had neuroinflammation was in 2015, and at least 3 doctors confirmed R1 did not have the diagnosis of PANDAS. Documents also showed that on 2/19/2022 R1 received a MRI that confirmed R1 does not have seizures or have a seizure disorder. LPA reviewed R1’s Individual Behavior Support Plan (IBSP) dated 8/27/21 and 6/27/22. The IBSP showed that R1’s Self-Injurious Behaviors (SIB) have decreased and there is a comprehensive plan to protect R1, especially in regards to R1’s Self-Injurious Behaviors against R1’s eye. The IBSP also discusses the level of SIB each day and how often it occurred. R1’s IBSP dated 8/27/21 stated that prior to R1 living at the facility, “from 7/1/21 through 7/27/21 (R1) engaged in SIB 1 an average of 7.33 episodes per day, SIB 2 an average of 2.70 episodes per day, and SIB 3 an average of 0.70 episodes per day.” R1’s 6/27/22 IBSP report stated (R1) engaged in SIB 1 an average of 3.23 episodes per day, SIB 2 an average of 1.58 episodes per day, and SIB 3 an average of 0.31 episodes per day. Overall, the IBSPs reported a general decrease in SIBs. Based on the support plan in place to meet R1’s needs, and confirmation from R1’s conservator and R1’s placement agency that the facility is an appropriate placement, the allegation is unsubstantiated.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022

LIC9099 (FAS) - (06/04)

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