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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507003353
Report Date: 05/18/2021
Date Signed: 05/26/2021 09:32:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ELITE FAMILY SYSTEMS, INC- SCOFFIELD HOMEFACILITY NUMBER:
507003353
ADMINISTRATOR:R PADILLA/ J SNEEDFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 0DATE:
05/18/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Bill SneedTIME COMPLETED:
04:00 PM
NARRATIVE
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On May 18, 2021 Licensing Program Analyst (LPA) Lidia Tinoco conducted a Tele-Visit Case Management inspection with the Elite Family Systems and met with Bill Sneed. The purpose of the inspection was to discuss information discovered during the investigation of a complaint.

During the investigation it was discovered that in January 2021 the agency was experiencing a shortage of staff, at the Scoffield House, the staff ratio was 2 staff to 6 children. On 1/26/21 a child in the home was restrained by a staff and an untrained staff observed the restraint which resulted in injury. When LPA asked staff if it was a choice to reach out to another house for help it was stated that it was not an option due to being short staffed. Per Bill this information is not true, and it was a possibility to reach out to other staff for support. While LPA reviewed the incident reports for 1/26/21 LPA observed that there was missing pertinent information in the report. LPA addressed these concerns with Bill Sneed. Bill and LPA Tinoco discussed the information that needs to be included in incident reports, Bill stated he will be making those corrections by retraining staff.



The Department determined this to be an immediate risk to health and safety of the children in care at this time, therefore the Facility was cited for The Interim Licensing Standard (ILS) Chapter 7.5 Version 3.1 Articles 1 through 10. The Agency is being cited for violations of Sections 87095.65(a)(1) Emergency Intervention Staff Training and 87095.61(b) Documentation and Reporting Requirements.

Due to COVID-19 An exit interview was conducted over the phone, and a copy of the report and appeal rights were provided to the facility via email. Signatures were also requested via email and will be documented on an LIC812.

SUPERVISOR'S NAME: Melanie KrageTELEPHONE: (559) 650-7905
LICENSING EVALUATOR NAME: Lidia TinocoTELEPHONE: (559) 650-7868
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ELITE FAMILY SYSTEMS, INC- SCOFFIELD HOME
FACILITY NUMBER: 507003353
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/19/2021
Section Cited

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87095.65(a)(1). (a) No staff shall use emergency intervention techniques on a child until they have obtained written certification from the training instructor for successfully completing the emergency intervention training required in Section 87095.65(b).
(1) All new and existing staff who use or participate in emergency interventions, as well as the facility administrator and the administrator's designee must complete the training.

This requirement is not met as evidenced by:
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Based on interviews and record review, the licensee failed to adequately staff the facility with staff trained in restraints, which poses an immediate health, safety, or personal rights risk to residents in care.
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Type A
05/19/2021
Section Cited

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87095.61(b). (b) The administrator or administrator's designee must determine whether the emergency intervention action taken by the staff member(s) was consistent with the emergency intervention plan, and document the findings in the child's record and facility monthly log as specified in Section 87095.61. The manual restraint review must evaluate the following:...

This requirement is not met as evidenced by:
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Based on interviews and record review, the licensee failed to properly complete and review incident reports being submitted, which poses an immediate health, safety, or personal rights risk to residents 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.
SUPERVISOR'S NAME: Melanie KrageTELEPHONE: (559) 650-7905
LICENSING EVALUATOR NAME: Lidia TinocoTELEPHONE: (559) 650-7868
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2021
LIC809 (FAS) - (06/04)
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