565800360-9-8-2023-29-AS-KBUY-CW2VY2-20230926165026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800360
Report Date: 09/08/2023
Date Signed: 09/08/2023 12:13:45 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
05/11/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230511155340

FACILITY NAME:	ARC-OJAI ENRICHMENT CENTER		FACILITY NUMBER:	565800360
ADMINISTRATOR:	AMBER LUNDEEN		FACILITY TYPE:	775
ADDRESS:	210 CANADA		TELEPHONE:	(805) 646-5186
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	105	CENSUS: 54	DATE:	09/08/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Andrea Tillman, Supervisor		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff did not provide adequate supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenny Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA conducted the 10 day visit and requested relevant documents on 5/18/23. LPA Olson interviewed reporting party on 5/19/23, Administrator and staff on 5/18/23, C1's Service Coordinator on 8/9/23, and Behavorist on 8/21/23. LPA Olson met with Supervisor and explained the purpose of the visit.

On the allegation: Staff did not provide adequate supervision. It was alleged Client 1 (C1) was not provided adequate supervision (C1 has a 1-to-1 aid) and was able to access a computer and became violent. Complainant also alleged that this happened previously a few weeks prior and this shouldn’t have happened due to having a 1-to-1 to ensure C1 doesn’t access the computers or the internet. LPA interviewed staff and reviewed documents. C1 was given a 1-to-1 in order to prevent access to computers and the internet. Interviews with staff revealed that on 5/5/23 C1 got up, walked into the office next door with a staff behind (Staff 1- S1), asked to come in, and was granted access. Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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-20230511155340

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: ARC-OJAI ENRICHMENT CENTER	FACILITY NUMBER: 565800360
	VISIT DATE: 09/08/2023

NARRATIVE

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Staff 2 (S2) turned the computer screen off and said they could come in thinking it would lock itself. C1 then tried to access the computer, turned on the screen and was able to browse the internet. S1 and S2 tried to redirect C1 off the computer but were unable to. A few minutes later, S1 unplugged the computer to stop access and C1 charged out of the room and destroyed property. Staff interviewed revealed that this happened a few days before as well and staff were able to turn off the computer and there was no behavior. Therefore, they thought it would work again this time. C1 was issued an immediate termination and asked to not come back to the day program. The immediate termination will be addressed in Case Management Visit.

LPA reviewed C1’s file which states there have been challenges regarding behavioral episodes resulting in injury to staff and C1. The team are working together to address the challenges and maintain a happy and safe environment for C1. Family provided helpful insight for supporting C1 and has been doing well since, having only 2 minor incidents where C1 was easily redirected. “Going forward we plan to discuss the possibility of behavioral services to create a behavior plan for C1 at Day Program.”

A Family Member (FM) stated there was a behavior plan put in place where C1 was assigned a 1-to-1, offices would be locked, computers would have passwords, and there would be an internet free area for C1. FM stated C1 gained access to the internet twice prior to this meeting and twice following the meeting and the facility did not implement the plan. Family Member stated if staff would have followed the plan and locked their computer prior to C1 coming into their office, this would have never occurred.

Administrator stated they could never guarantee C1 won’t gain access to a device or computer, stating their program isn’t made that way. Administrator stated their computers and iPad’s have a password for login and will sleep and lock after 60 minutes. LPA suggested facility conduct a training on how staff should lock their computer properly and decrease the time to 15 minutes.

LPA interviewed C1’s Service Coordinator and Behaviorist who stated that the facility had a plan in place establishing particular rooms would remain locked to prevent C1 from accessing electronic devices as well as adding a password to devices to restrict access to C1. Behaviorist stated C1’s primary 1-on-1 should have followed C1 out of the room on May 5, instead of C1's backup 1-on-1 and may have been more successful at de-escalating C1. Behaviorist stated C1’s primary 1-on-1 had the most training and experience with C1 and should have been with C1 when they left the room. The facility did not provide adequate supervision by not properly implementing C1’s behavior plan therefore, not meeting C1’s needs by allowing C1 to gain access to a computer on 2 occasions. Based on the information obtained, the allegation is Substantiated at this time. Exit interview completed, copy of report and appeal rights were issued.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230511155340

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: ARC-OJAI ENRICHMENT CENTER	FACILITY NUMBER: 565800360
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/11/2023 Section Cited CCR 82065(a)	1 2 3 4 5 6 7	82065 Personnel Requirements (a) Program personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to submit a statement of understanding of regulation 82065 and ensure staff are implementing clients behavior plan and properly trained to do so by 9/11/23.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply in the section cited above when staff did not properly follow C1's behavior plan, which posed an immediate health and safety risk to persons 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: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC9099 (FAS) - (06/04)

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