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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 027005048
Report Date: 09/01/2022
Date Signed: 09/01/2022 12:30:16 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, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2022 and conducted by Evaluator Tamara Jensen-Hill
COMPLAINT CONTROL NUMBER: 23-CR-20220510175101
FACILITY NAME:ROP QUALIFYING HOUSE MT. RUBYFACILITY NUMBER:
027005048
ADMINISTRATOR:TRACY EDWARDSFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: DATE:
09/01/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Lack of supervision resulting in a serious altercation between clients
Facility did not report incident as required
Lack of supervision allowing a youth to leave the facility undetected
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 9/1/22 at 11:00 AM and met with Tracy Edwards, Administrator to discuss the findings of the allegations.

LPA Hill informed Ms. Edwards that the complaint investigation included an initial inspection at the facility on 5/16/2022 and collateral inspection at the administrative offices in Minden, NV, to interview staff and clients involved in the incidents. LPA interviewed C1, C2, and C3 (see LIC811 dated 9/1/22) and staff while at the administrative offices and obtained documentation related to the clients and incidents under investigation.

LPA informed Ms. Edwards that the allegation regarding lack of supervision resulting in a serious altercation between clients happened on 5/5/2022 while at the facility in which two clients stepped out on the back patio of the facility and engaged in a physical altercation without staff detection. When interviewed, the clients refused to disclose that anything had happened but there was evidence that something had happened as
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jodean Greene
LICENSING EVALUATOR NAME: Tamara Jensen-Hill
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
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 23-CR-20220510175101
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833
FACILITY NAME: ROP QUALIFYING HOUSE MT. RUBY
FACILITY NUMBER: 027005048
VISIT DATE: 09/01/2022
NARRATIVE
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C1 was observed to be red in the face and have a swollen or bloody lip following the incident. It was also alleged that this incident was not reported to Licensing as required. LPA obtained a copy of a draft incident while at the agency on 5/16/2022. This report was not sent to Licensing. When staff reviewed the cameras at the facility, it was disclosed that there were no staff supervising the youth in the living area at the time of the incident which allowed the youth the opportunity to step outside, outside of view of any cameras at the facility, and engage in the altercation. As a result of the interviews conducted and review of the cameras, the allegations that there was a lack of supervision allowing the youth to engage in a physical altercation and that the facility failed to report the incident to Licensing as required are SUBSTANTIATED at this time meaning that the "preponderance of the evidence" standard has been met.

The allegation that a lack of supervision resulted in a youth to leave the facility undetected is related to an incident that happened on 4/26/22 in which C2 was able to leave the facility and be gone for multiple hours without staff knowing. When interviewed, C2 admits to leaving the facility around midnight on 4/26/22 but S1 failed to notice that C2 was gone until 2 AM. When the administrator reviewed the cameras for the evening of 4/25/22 to the early morning of 4/26/22, S1 failed to conduct the nightly checks according to the agency policy which requires youth to be checked on every 15 minutes and for staff to verify that they see skin when checking on youth. As a result of the information obtained and interviews conducted, the allegation that a lack of supervision resulted in a youth leaving the facility undetected and being gone for hours is SUBSTANTIATED at this time meaning that the "preponderance of the evidence" standard has been met.

As a result of the allegations substantiated, the facility was cited for Title 22, California Code of Regulations, General Regulations, 80078(a) Responsibility for Providing Care and Supervision as staff failed to supervise youth appropriately to prevent an altercation that took place on 5/5/2022 between C1 and C2, out of camera view and with no staff present. In addition, staff failed to appropriately supervise youth on 4/26/22 leading to C2 being able to leave the facility undetected and being gone for approximately two hours prior to staff knowing. The facility was also cited for Title 22, California Code of Regulations, General Regulations, 80061(a) Reporting Requirements as the agency failed to report the altercation between C1 and C2 that happened on 5/5/2022. The incident was not provided to Licensing until LPA Hill obtained a copy while initiating the complaint investigation on 5/16/2022.

Exit interview was conducted with Ms. Edwards and documents were provided via email along with appeal rights.
SUPERVISORS NAME: Jodean Greene
LICENSING EVALUATOR NAME: Tamara Jensen-Hill
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 23-CR-20220510175101
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833

FACILITY NAME: ROP QUALIFYING HOUSE MT. RUBY
FACILITY NUMBER: 027005048
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2022
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. This was not met as evidenced by
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S1 was verbally counseled about the lack of supervision and subsequently left the agency. The administrator did discuss the incident and verbally counseled other staff in the second issue about supervision at all times.
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Based on interviews conducted, staff failed to supervise youth appropriately to prevent an altercation that took place on 5/5/2022 between C1 and C2 as no staff were present in the room. In addition, staff failed to appropriately supervise youth on 4/26/22 leading to C2 being able to leave the facility undetected and be gone for approximately two hours without staff knowledge which poses an immediate Health, Safety or Personal Rights risk to clients in care.
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Administrator will retrain night staff on the supervision policy at night and all staff will be trained on providing supervision at all times during the day shift as well. This training shall include 15 minute bed checks and the observation of seeing skin on the youth at night and being present during day.
Type B
09/01/2022
Section Cited
CCR
80061(b)
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Reporting Requirements. Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. This was not met as evidenced by
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Administrator will ensure that when they are absent there will be a staff person to cover them for the incident reporting so as to not have a lag in reporting or a report that is neglected to be reported.
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The facility did not report an altercation or alleged incident between C1 and C2 that happened on 5/5/2022. The incident was not provided to Licensing until the complaint investigation was initiated on 5/16/2022 which poses a potential Health, Safety or Personal Rights risk to clients in care.
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Email acknowledgement will be sent to LPA by close of business 9/1/22.
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: Jodean Greene
LICENSING EVALUATOR NAME: Tamara Jensen-Hill
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5