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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850084
Report Date: 08/30/2023
Date Signed: 08/30/2023 12:54:20 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
04/05/2023 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20230405081052
FACILITY NAME:DEVEREUX CALIFORNIA - TULAROSAFACILITY NUMBER:
425850084
ADMINISTRATOR:PATTON, CHRISTOPHERFACILITY TYPE:
737
ADDRESS:1855 TULAROSA ROADTELEPHONE:
(805) 879-0357
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:3CENSUS: 2DATE:
08/30/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Chris Patton, AdministratorTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Clients are not accorded dignity in their personal relationships with staff
Facility is operating out of staff ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA met with Administrator and explained the purpose of the visit. LPA was accompanied by Tri-Counties Regional Center Quality Assurance Specialist (QAS) Vincent Figueroa. LPA interviewed staff on 4/13/23 at 1pm, 1:40pm, 2:23pm, 3pm, 3:43pm, and 4:26pm; 4/21/23 at 11:05, 11:45am, 2:23pm, 3pm, and 3:35pm; 4/24/23 at 2:19pm; 4/25/23 at 7:40am, 4/28/23 at 1:40pm and 3:05pm; 5/2/23 at 1:10pm and 1:50pm; 5/3/23 at 3:40pm and 5pm; and Administrator on 5/11/23 at 1:05pm.

On the allegation: Clients are not accorded dignity in their personal relationships with staff. It was alleged that Staff 1 (S1) mocks and provokes Client 1 (C1) that results in behaviors. It was also alleged that S1 is inpatient, is quick to do a full or partial physical prompt instead of a verbal or gesture prompt, and C1 punched S1 in the face once because of this, which is not a typical behavior. 20 current and previous staff were interviewed for the investigation, in addition to the administrator.
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
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 5
Control Number 29-AS-20230405081052
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: 08/30/2023
NARRATIVE
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When asked if there was a staff that did anything that made them feel uncomfortable, 15 out of 20 staff stated Staff 1 and 10 out of 20 stated Staff 2 (S2). Staff interviewed stated S1 is very rude, cocky, over prompts C1, has a negative tone of voice, and often gets frustrated with staff and C1. Staff interviewed stated S2 is bossy, says they’re “over it”, and prioritizes their office job away from clients over helping staff with C1. Based on the information obtained, the allegation is deemed Substantiated at this time.

On the allegation: Facility is operating out of staff ratio. It was alleged Staff 2 (S2) leaves staff on the floor by themselves or with an uncleared trainee and goes in the office to work unless they are asked for help. Interviews reveal that multiple staff have reported that Staff 2 has left them alone or with another staff to do work in the office all day. One staff stated that they don’t feel comfortable telling S2 that they need to stay on the floor when the staff are out of ratio. Staff interviewed indicated it is very clear that C1 requires 2 staff at all times per C1’s care plan, and that all staff know the priority is to be in the 2 to 1 ratio to ensure C1 is safe and adequately cared for. Staff interviewed stated they knew office work is secondary and they should stay on the floor to maintain ratio, without being asked. Another staff stated they said they needed help and was not comfortable being alone on the floor. Staff stated that S2 said “I’m needed in the office” and walked away, leaving C1 out of ratio. Two staff stated they asked S2 for support on 3/21/23 because one staff was new and in training, and was not cleared to count in the ratio yet. Staff reported S2 said that the staff had been clear per the Administrator and left them alone and went to the office, leaving them out of ratio. Interview with S2 revealed that they thought the new staff was cleared to work, then stated the Administrator informed them they were not and still in training. S2 stated they then were on the floor, in ratio, until C1 went to sleep. S2 said after C1 went to bed they went to the office and told the two staff to call if they needed help, knowingly leaving C1 out of ratio. Based on the information obtained, the allegation, Facility is operating out of staff ratio is Substantiated at this time.

On 4/7/23 the facility placed staff 1 and 2 on a leave of absence while they conducted an internal investigation. On 6/20/23 the facility informed LPA that they concluded their investigation and that Staff 1 was terminated and Staff 2 was removed from their supervisor role and will be transferred to another facility.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).

Exit interview conducted, copy of report, citations, and appeal rights issued.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 29-AS-20230405081052
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2023
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirment was not met as
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Administrator scheduled personal rights training for all staff on 8/25/23 and 8/30/23 and agreed to submit training records to CCL by 9/1/23.
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evidenced by: Based on interviews, the Licensee did not comply with the section cited above when Staff 1 and 2 did not treat C1 with dignity, which posed an immediatel personal rights risk to client in care.
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Type A
09/01/2023
Section Cited
CCR
85065.5(a)(1)
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85065.5 Day Staff-Client Ratio
(a)…the following minimum staffing requirements shall be met: (1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center…This requirement was not met as evidenced by:
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Administrator agreed to submit a plan to ensure staff are supporting C1 in proper ratio and submit plan to CCL by 9/1/23.

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Based on interviews the licensee did not comply with the section cited above when S2 left the floor to work in the office and put staff out of ratio, which posed an immediate health and safety risk to 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: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
04/05/2023 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20230405081052

FACILITY NAME:DEVEREUX CALIFORNIA - TULAROSAFACILITY NUMBER:
425850084
ADMINISTRATOR:PATTON, CHRISTOPHERFACILITY TYPE:
737
ADDRESS:1855 TULAROSA ROADTELEPHONE:
(805) 879-0357
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:3CENSUS: 2DATE:
08/30/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Chris Patton, AdministratorTIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Facility staff is not properly reporting incidents.
INVESTIGATION FINDINGS:
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3
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5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA met with Administrator and explained the purpose of the visit. LPA was accompanied by Tri-Counties Regional Center Quality Assurance Specialist (QAS) Vincent Figueroa. LPA interviewed staff on 4/13/23 at 1pm, 1:40pm, 2:23pm, 3pm, 3:43pm, and 4:26pm; 4/21/23 at 11:05, 11:45am, 2:23pm, 3pm, and 3:35pm; 4/24/23 at 2:19pm; 4/25/23 at 7:40am, 4/28/23 at 3:05pm and 1:40pm; 5/2/23 at 1:10pm and 1:50pm; 5/3/23 at 3:40pm and 5pm; and Administrator on 5/11/23 at 1:05pm.

On the Allegation: Facility staff is not properly reporting incidents. It was alleged that Staff 1 (S1) pushed Client 1 (C1) aggressively and Staff 2 (S2) told S1 not to, stating they would get in trouble and get fired. It was also alleged that S2 does not let people speak and told another staff who witnessed it not to report it. 20 current and previous staff were interviewed. None of the staff interviewed admitted to witnessing anyone push or shove C1.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20230405081052
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: 08/30/2023
NARRATIVE
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None of the staff interviewed stated they were aware of or had heard of any incident that was not reported per regulation. Based on the information obtained the allegation is Unsubstantiated at this time.

Exit interview conducted, copy of report was issued..
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5