Complaint Investigation Report

Staff do not provide adequate care and supervision of a client. It was alleged that C1 went into a large garbage bin, fell asleep inside the bin and then got taken to drop off waste area.

Interviewed Administrator and staff denied that staff do not provided adequate care and supervision to clients. They stated there are always enough staff at the facility for care and supervision. Interviewed Administrator and S1 stated that C1 was not seen at the facility around 8:00 pm on 07/02/25. They stated that was not alarming at the time because in the past C1 has walked to their FM house and returned back. FM was always contacted and they return C1 to the facility. FM was contacted and notified that C1 was not at the facility. Administrator also contacted to C1's Case Manager from the Placement Agency and therapist. Administrator stated on 07/03/2025, before a missing person report could be made, Azusa Police Department had made contact with her and notified that C1 had got into a dump truck and ended up at the drop off waste area. C1 had no injuries and stated that they had just fallen asleep in the dumpster. For precautionary reason C1 was transported to the Hospital. Administrator indicated when C1 first arrived, they would soil themself, in a protest manner. C1 had hopes that the facility would evict them, and C1 would be able to go home. Administrator said C1 may have used this incident (went into a garbage bin)as another form of protest, because C1 wants to return home, even though that is not an option for C1 anymore. Administrator stated upon discharge planning Crystal Manor will follow medical advice to see if C1 is still eligible to be at facility level, or if C1 is in need higher level of care and supervision. Interviewed CM stated after they notified about the incident, they went to the hospital for evaluation. It was determined that C1 met criteria for 5150 hold for danger to self. Interviewed FM stated that they knew that C1 is at the hospital. FM indicated that Facility administrator and CM called them and notified about the incident. On LPA's question if they have any additional information they stated that they not a responsible party for C1 and C1 is adult and can take care of themselves. Interviewed clients stated that they didn't hear about the incident. Client interviews do not corroborate the allegation.