Complaint Investigation Report, 10/31/2023 — Solano House, Fairfield CA

Although occurred, staff S1 responded in a timely manner and was able resolve the altercation. Staff S1 attempted to contact additional staffing support but was unable to reach staff through radio walkie system. Additional staff arrived at approximately 3 1/2 minutes after the altercation was de-escalated but were unaware of the event. Based on a review of the facility Policies & Procedures in the "Staffing Ratio and Work Hours" section; it is indicated that a minimum of three Behavioral Health Technician (BHT) Staff are to be present from 10:00am - 8:00pm. Upon review of staffing schedule for the dates: 9/16/2023, 9/29/2023 & 10/31/2023, LPA found that the facility met their program requirements for staffing and supervision. Due to a lack of corroborating evidence and conflicting information, the allegation is found to be unsubstantiated.

Complaint alleges staff are not onsite leaving residents unsupervised. Based on a tour of the facility and LPA observations over multiple visits to the program (9/29/2023 & 10/31/2023), LPA observed a sufficient amount of staff present providing supervision for clients in care based on facility staffing ratio policy. LPA reviewed staff time sheets confirming which staff are present during program hours. LPA conducted interviews with several staff. Based on interviews with staff (S1, S3, S4 & S6) there was indication of a lack of overall staff supervision. However, LPA received conflicting statements regarding staff being observed to leave the facility premise and leaving clients unattended. In addition, LPA found staffing to be sufficient during visits in compliance with the facility staffing ratio policies. Due to a lack of corroborating evidence the allegation is found to be unsubstantiated.

Allegations, staff did not prevent an altercation between residents & staff are not onsite leaving residents unsupervised are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.