525001162-4-18-2023-59-AS-KHOS-CR8MAH-20230425092620

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525001162
Report Date: 04/18/2023
Date Signed: 04/18/2023 10:08:03 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20230315160237

FACILITY NAME:	PRS - SOUTHPOINTE RETREAT		FACILITY NUMBER:	525001162
ADMINISTRATOR:	SCHLOTTMAN, LAURIE		FACILITY TYPE:	740
ADDRESS:	1340 SOUTHPOINTE DR		TELEPHONE:	(530) 527-2135
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	6	CENSUS: 4	DATE:	04/18/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Laurie Schlottman, administrator		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff pushed a resident while in care - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

04/18/2023 09:30 AM Licensing Program Analysts (LPA)s Rebecca Knight and Sarah Benson made an unannounced visit to the facility and met with administrator Laurie Schlottman. The purpose of this visit was to deliver the results of a complaint investigation. Prior to initiating the visit, LPAs self-screened for symptoms of COVID-19 infection, and ensured they applied hand sanitizer before entering the facility.

During the course of the investigation the administrator, 1 client, and 3 staff were interviewed. LPA reviewed the following documents: related incident reports, Physician’s report, Admission Agreement, IPP for 1 client, staff list with telephone numbers, client list, police report.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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 2

Control Number 59-AS-20230315160237

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: PRS - SOUTHPOINTE RETREAT	FACILITY NUMBER: 525001162
	VISIT DATE: 04/18/2023

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

Staff pushed a resident while in care - UNSUBSTANTIATED

LPA reviewed a report from Red Bluff Police Department dated 3/15/2023. The report stated that an officer was dispatched to the facility responding to a call. During the visit Client 1 (C1) was unable to provide the officer with any details. The facility administrator provided the officer with detail of an incident that was reported in November 2022 in which C1 claimed that Staff 1 (S1) had pushed C1 down. The investigating officer then referenced another police report dated November 27, 2022, in which C1 had claimed that S1 had pushed C1 to the ground during an argument over the hallway light being on. During the argument C1 called the Red Bluff Police Department who responded to the facility. While officers were on scene, C1 acted as if they had been pushed, and fell to the ground and began faking a seizure. When medical arrived, they stated that C1 appeared to be faking the seizure but took C1 to the hospital to be checkout out. This incident was unfounded by the visiting officer.

2 of 3 staff stated that Client 1 (C1) got into an argument with Staff 1 (S1) about the light being off. 2 of 3 staff stated that C1 called the police. 1 of 3 staff stated that C1 had a seizure in front of the police officer. 1 of 3 staff stated that C1 faked a seizure in front of the police officer.

Client 1 stated they had a seizure quite a bit ago, C1 could not recall the name of the staff they thought had pushed them.

Administrator stated In November 2022 C1 got upset because staff turned off the hall light. C1 called 911. Staff 1 told the administrator later that C1 had fell to the ground and had a seizure while talking to the police officer in the facility. 911 was called, it was reported as a medical incident. C1 recently made the allegation during a ZOOM call with the State Council on Developmental Disabilities.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to administrator Laurie Schlottman.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2