40. Unannounced Visit: Voyeurism Copy

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Facility Type: 730/733 (Group Home)

Lack of care and supervision.

Investigation Findings
LPA made an unannounced visit on this date and met with Administrator to discuss the allegations as stated above. Although findings were discussed on 9/13/18, documentation was finalized on 9/14/18.

The incident that led to the complaint is one in which a social worker came to the dorm and observed C1 (see LIC811 dated 9/13/18) in her room partially dressed with a male client C2 in the window without staff knowledge. Staff was informed that C2 was in the window and staff immediately went to the room to direct C2 to leave the area and not hang out in the windows of the female clients. Upon entering the room, staff became aware that C3 was also in the dorm without her knowledge and had apparently returned to the dorm via the window. Staff admitted to being out of ratio in that there was one staff person in the dorm with the four clients prior to one client’s unauthorized absence. LPA informed administrator that the investigation proved that there was one staff person in the dorm with four clients proving that there was a lack of supervision. As a result of the investigation, the complaint allegation is SUBSTANTIATED meaning that the allegation is valid because the preponderance of evidence standard has been met.

Facility cited for violation of California Code of Regulations, Title 22 Division Six, regulation 80022(k) Plan of Operation. An immediate civil penalty is issued for repeat violation. Documents and appeal rights were provided to the facility on this date.

Deficiency Type /
Section Number
Type A
Section Cited
Plan of Operation - The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. This is not met as evidenced by:
Facility's plan of operation states they will have a 1:3 ratio in the day and they did not have the appropriate ratio as stated. Investigation proved that at the time of the incident, staff person was alone in the dorm and there were four clients present in the dorm.
Facility Ratio is currently 1:3 and facility shall ensure that that ratio is met at all times. Facility shall review the Emergency Intervention Plan to ensure that not only is the ratio met but that the needs and services of the youth in care are being met given the high acquity [sic] of the youth in care.
Facility shall provide a copy of the updated written Emergency Intervention Plan and plan of operation as applicable by 10/15/18.


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