425850084-2-12-2024-29-AS-KBUY-D2W2YG-20240228164842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850084
Report Date: 02/12/2024
Date Signed: 02/12/2024 11:16:57 AM

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
08/30/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230830134758

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: 3	DATE:	02/12/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Chris Patton, Administrator		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Client is being abused at the facility.
Medical treatment is being denied.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
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 Olson collaborated with Tri-Counties Regional Center Quality Assurance Specialist (QAS) Vincent Figueroa on the investigation and interviewed staff on 6/1/23 at 10:16am, 11:45am, and 12:19pm; 8/30/23 at 11am, 11:46am, and 12:12pm; 9/15/23 at 2:40pm and 3:08pm; 9/26/23 at 2:41pm and 3:25pm; Administrator on 5/31/21 at 8:08am, 6/1/23 at 9:50am, 9/15/23 at 3:30pm; 2/5/24 and 2/7/24 .LPA met with Administrator and explained the purpose of the visit.

On the allegation: Client is being abused at the facility. It was alleged that Client 1 (C1) was being abused at the facility, due to the facility not following C1’s requests to see, talk to, and/or be with C1’s family. Reporting party states the facility is isolating C1 from their family and friends, and restricting visitation and calls.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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 3

Control Number 29-AS-20230830134758

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: 02/12/2024

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

C1 has a conservatorship where the conservator has full rights over C1 including placement and visitation. The conservator outlined Visitation Guidelines for C1 and has the authority to change and alter it. On 1/27/23 the Limit of Powers of Temporary Conservatorship was petitioned and court and a judge denied the request on 08/11/2023. It states, “In summary, the evidence supports the Courts’ previous orders authorizing the temporary conservator to limit [C1’s] social and sexual contacts. The evidence further shows the [conservator] has exercised this power reasonably. [Contester] fails to show the [conservator] is abusing its authority by implementing and enforcing the Guidelines, including the Challenged Guidelines.” Staff interviewed indicated they follow the conservator’s guidelines for visitation with C1. Based on the information obtained, the allegation is deemed Unsubstantiated.

On the allegation: Medical treatment is being denied. It was alleged that Client 1 (C1) is not receiving the medical treatment they require. It was alleged that C1 does not have a Primary Care Physician (PCP) and needs to see a Physical or Occupational Therapist, Rheumatologist, Immunologist, and the facility is ignoring C1’s diagnoses and physician ordered diet. It was also alleged that C1 has experienced dangerous weight gain. It was alleged that C1 was below 130 pounds when they moved in. In November/December 2021, C1 was allegedly 135 pounds and 3-4 months ago C1 weighed 160 pounds. Allegedly 3-4 months ago the facility implemented a new PRN protocol and since then C1 gained another 20 pounds and is now 180 pounds. It was also alleged C1 is allergic to plyethylene glycol and has Ademia Fluid Retention that the facility is ignoring.

LPA interviewed Administrator, who stated C1’s planning team decided to change PCPs recently. In January 2024, C1’s conservator signed paperwork to switch C1’s PCP to a new doctor and was subsequently removed from their previous one. C1 was scheduled to see their new PCP on 2/23/24. Administrator stated during the transition, C1 received any needed medical care through the Emergency Room (ER) or Urgent Care (UC).

LPA observed C1’s records from medical visits, and noted C1 sees their psychiatrist once per month. C1 last saw a dentist on 12/13/23 for a cleaning, x-rays and filling. C1 went to the ER on 1/2/24 for cold symptoms and was diagnosed with an acute viral respiratory infection, but no antibiotics were required. Additionally once per month a dietitian/nutritionist reviews C1’s meals. Administrator also stated that on 1/9/24, C1 went to the ER for a self-inflicted wound and asked the doctor to refer C1 to a wound specialist and prescribe wound care, so C1 is receiving the necessary medical care. On 1/18/24 and on 2/1/24, C1 saw a wound care specialist for wound management. On 1/24/24 C1 saw their ophthalmologist for routine evaluation.
Continued on 9099-C (pg3)

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230830134758

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: 02/12/2024

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

On 2/7/24, C1 saw their eye specialist following a self-injurious behavior incident. The doctor noted the eye was stable and no damage was done.

LPA observed C1’s weight records. C1’s first weight record from the facility was from August 2021, and C1 weighed 164.6 – 175.0 lbs. Records indicated the following weight ranges for C1 during the timeframe of the complaint: August 2023, 163.0 lbs-169.4 lbs; September 2023, 162-174.6 lbs (facility started using a new scale on 9/3/23); October 2023, 173 -180lbs; November 2023, 170.8-172.6 lbs; December 2023, 171.2-178.2; January 2024, 168.4-180.2 lbs. Administrator stated they switched scales in September 2023 due to inaccuracy's of the daily weights. Additionally, Administrator stated the weight fluctuations did not appear substantial enough to be concerned by. For instance C1 weighed 178.5 on 1/3/24, 168.4 on 1/4/24, and 176.0 on 1/5/24. Administrator stated if C1 weighed in at 168 pounds again a second day in a row they would have flagged it and stated they would bring up any substantial weight gains or losses to C1’s nurse and or physician if needed. Additionally C1 is weighed every time they go to the doctor’s.

LPA asked Administrator if C1 has any allergies to medications or food, or if they were prescribed a special diet. Administrator stated C1’s family have claimed that C1 has allergies to food and medications, but have not provided proof upon request. Administrator stated they have asked C1’s previous doctors to screen C1 for allergies but they declined. Administrator stated they plan to ask C1’s new PCP to order allergy testing during the first visit on 2/23/24. LPA reviewed relevant paperwork for C1 and did not observe any noted allergies to medications or food. LPA reviewed C1’s Physician’s Report dated 06/07/2021 that states under Special Diet, no is checked and Assistive Device states “healthy diet!”. Additionally, no order for a special diet was observed.

Based on the information obtained, the allegation Medical treatment is being denied, is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report issued.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3