Complaint Investigation Report

Allegations #1: Staff provided a client access to harmful materials while in care.

Allegation #2: Staff did not provide adequate supervision to a client.

It was alleged staff #1 (S1) provided Client #1 (C1) with cleaning products and then left C1 unsupervised with the cleaning products. To investigate the allegation LPA Rios and LPA Casillas conducted an initial complaint investigation on 04/15/2025. On 4/15/2025 at approximately 11:40 a.m., LPA Casillas conducted a physical plant tour of the facility. LPA did not observe any health or safety issues. Also, on 04/15/25, at 11:56 a.m., LPA Rios attempted to interview client #2(C2). C2 declined to be interviewed. At approximately 12:00 p.m., LPA Rios requested and obtained copies of C1’s Individual Program Plan (IPP) from 01/30/2023 with addendums, and Quarterly Progress Report from consulting behaviorist dated 09/15/2024. At approximately 12:13 p.m., LPA attempted to interview client #3 (C3), C3 did not respond to LPA's questions. At 12:14 p.m., LPA Rios interviewed client #4(C4). At 1:21 p.m., LPAs interviewed a total of four (04) staff.

According to the Program Director (PD) clients do not handle chemicals such as cleaning products. PD also stated, when clients do participate in house cleaning staff will pre-mix cleaners in the mop bucket or spray the surface themselves. Interview with six (6) staff corroborates that when clients assist in cleaning the facility such as bedrooms, kitchen and bathrooms the staff handle the cleaning products and the clients are always supervised. However, LPA’s interview with C1 supported the allegation, stating that S1 provided them with a cleaning product and left them unsupervised. Conversely, LPA’s interview with S2 who was present on the day in question denied the allegation. According to S2, C1 became upset when S1 would not hand them the cleaning product. C1 was heard by S2 telling S1 they would get them fired. LPA's review of the facility program did not explicitly outline client participation in house chores but did include information on self-help and independence. Additionally, LPA’s review of C1’s Individual Program Plan (IPP) confirmed that C1 requires 1:1 supervision. The Quarterly Report also noted instances of C1 being triggered after making demands to staff regarding household chores. LPA's interview with C4; C4 denied both allegations, stating they are supervised when cleaning their bedroom and they use wipes to clean surfaces. LPA was unable to locate an additional witness to the allegation. Based on interviews, observations and document reviews the allegations, staff provided a client access to harmful materials while in care and allegation, and staff did not provide adequate supervision to a client are deemed Unsubstantiated at this time.

Exit interview conducted. Copy of report provided.