Complaint Investigation Report

On 07/03/2024, from 9:00 a.m. to 1:03 p.m., LPA T. Camara conducted an initial complaint investigation visit. Tri-Counties Regional Center (TCRC) Quality Assurance Specialists (QAS) Liz Aced-Arnett and QAS Patrick Brown were also present during the visit. Interviews were conducted with several staff between 9:16 a.m. and 11:51 a.m. Record review and obtaining pertinent documents started at 10:13 a.m.

On 07/17/2024, at approximately 11:00 a.m., Investigator Spindola conducted an interview with C1’s client representative; on 08/05/2024, from approximately 11:00 a.m. to 12:00 p.m., with C1’s client representative and witnesses; on 08/16/2024, at approximately 9:20 a.m., with C1’s respite worker; on 08/20/2024, from approximately 12:00 p.m. to 2:00 p.m., with the facility manager/administrator, supervisor, and staff; on 09/24/2024, from approximately 10:00 a.m. to 5:30 p.m., with S1 and C1’s respite worker; and on 09/27/2024, at approximately 11:00 a.m., with C1’s client representative. In addition, the investigator reviewed Community Memorial Hospital (CMH) Ojai medical records, Clinicas Del Camino Real Ojai Health Center medical records, facility internal investigation report, photos of C1’s injuries, and facility file documents pertinent to C1 and the investigation.

A review of the Department of the Developmental Services (DDS) client evaluation report, dated 10/16/2023, documented C1’s diagnosis as moderate intellectual disability, epilepsy, requires constant supervision during waking hours to prevent injury/harm in all settings, not toilet trained, no control of bladder or bowel, non-verbal, uses wheelchair, walks alone 10 feet, but unsteady.

According to C1’s pre-admission physicians report, dated 06/07/2024, C1 required help with dressing, personal hygiene, toileting, using the bathroom, incontinent, and required assistance with eating sometimes. Communication was listed as non-verbal communicates by using sounds and movements. The report also listed C1 had a diagnosis of cerebral palsy, developmental issues, history of seizures, muscular atrophy, can walk with support, and uses stroller.