THE INVESTIGATION; CLASS - Narconon...

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY /OP 601 SL. Revised 02/08

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California

Department of Alcohol and Drug Programs LicGnslng and Cenlflei:l.tion Oivi:sion

1700 K Street, Sacramento, CA 95811 TDD (916) 445·1942, Fax (916) 322·2658

(916)322-2911

COMPLAINT INVESTIGATION NUMBER:

10-0500

REFERENCES; (1) Heal1h and Safety Cocle Secllon 11834.01 and Californla Code of Regulatlons (CCR), Tille 9, Section 10502. Depart.mental Aut~orily lo License. (2) Heal1h and Human Services Agency, Depal"\ment of Alcohol and Drug Program5, Alcoliol and/or Other Drug Program Certlflcat1on Slandard:s.

PROGRAM/FACILITY LEGAL NAME:

Nacronon of Northern California

ADDRESS (Slreet, City and Zip): 262 Gaffey Road, Watsonville, CA 95076 TYPE OF INVESTIGATION:

DATE OF SITE VISIT:

November 7, 2011 and November 8, 2011

TYPE OF PROGRAM/FACILITY: (Please cheo~ all that applies)

D COMPLAINT D FOLLOW-UP [8l RESIDENTIAL D NONRESIDENTIAL D DETOXIFICATION D NTP D DUI

O UNLICENSED [8J DEATH D DMC CERTIFIED O ADOLESCENT D PERINATAL

O COUNSELOR MISCONDUCT - The Counselor Investigative Report may be referred upon.

[8l AOD LICENSED

[8l AOD CERTIFIED O COUNTY OPERATED O CDCR AFTER CARE PROGRAM

THE FOLLOWING INVESTIGATIVE REPORT IS BEING ISSUED AS A RESULT OF THE INVESTIGATION:

ONO DEFICIENCY (Licensed and/or_Gertified Programs)

[8J DEATH INVESTIGATION (Licensed and/or Certified Programs)

[81 CERTIFICATION (AOD Certified Programs)

[g] NOTICE OF DEFICIENCY (Licensed Programs)

O NOTICE OF OPERATION IN VIOLATION OF LAW (Unlicensed Programs)

01NTERDEPARTMENTALREFERRAL

The investigation was conducted in accordance With California Code of Regulations (CCR), Title 9, Chapter 5, andfor the Alcohol and/or Other Drug

Program Certific:afion Standards which may include the following: Inspection of the program premises, review of program policies, procedures,

staff and resid"ent flle(s), :and the Interview of residents and staff. In addition, the complaint Investigator shall notify the llcensed and/or certified

program/facility' director or his/her desigriee of the allegation(s) during the e.:it conference. (The ADP 9080, Detall Supportive Information form and

ADP 7025, Confidential Names for~ may be referred upon.)

TELEPHONE: 916 445-9153 TELEPHONE: 916 327-5693

I HAVE READ THE PROGRAM INVESTIGATIVE REPORT AND I UNDERSTAND MY APPEAL RIGHTS.

PROGRAM/FACILITY REPRESENTATIVE DATE Please .sign above, in/1/af any following paoes and return the oriaina/ to ADP.

TELEPHONE NUMBER:

/2--DATE

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY AOP 6015L, R.~vlsed 01/0B

Pepartrnenl ol Alcohol :nd Drug Progr:iims l..lcenslng and Certific.-tJon blvislon

1700 K Str1:1et, Sactamen\o, CA 95811 TOO (916) 446-1942, Fox (916)322·2658

(916)322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER:

1

PROGRAM/FACILITY NAME: l COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California - 10-0500 REFERENCES: (1) Health and Safely Code Seclion 11834.01 a11d California Code of Regulations (CCR). Tille 9, Section 10502. D~partmental Authority lo License.

(2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Ali::ohol andfor Other Dru!il i:>rogram Certiflcaliori Standards.

FINDINGS

THE FOLLOWING DEFICIENCY{IES) WERE IDENTIFIED AND SUBSTANTIATED DURING THE COURSE OF CLASS THE INVESTIGATION;

1. Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's A death until one vear after the death of Decedent.

2. Licensee did not send a report of the death of Decedent until one year after Decedent's A death.

3. Licensee provided an inaccurate statement to the Department of Alcohol and Drug B Proo rams.

4. Licensee did not possess policies and procedures ensuring Decedent sought timely A medical treatment

5. Licensee did not ensure Decedent was afforded safe, healthful and comfortable A accommodations to meet Decedent's needs.

6. Licensee staff did not complete the required Resident Health Screening for Decedent B

7. Licensee did not ensure its counseling staff was licensed, certified, or registered six B months from date of hire.

8. Licensee failed to ensure personnel are tested for Tuberculosis annually. B

INVESTIGATIVE SUMMARY

Investigative Procedure Complaint Analyst (Hereinafter "CA Alatorre") made an unannounced investigative visit to Narconon of Northern California ("Licensee") at the above address to investigate death investigation number 10-0840 and complaint numbers 10-030, 10-059, 10-152, and 11-030 on November 7, 2011 and November 8, 2011, respectively.

Upon arrival at the Licensee's address, CA Alatorre presented Licensee's Senior Director of Administration, Nathan Tuddenham (Hereinafter "SDA Tuddenham"), with a signed Notice of Inspection of Confidential Records and a signed Notice of Retention of Confidential Records. CA Alatorre requested that the documents be dually signed by the Executive Director or designee and requested copies of the two aforesaid documents. SDA Tuddenham returned an executed copy of the Notice of Inspection of Confidential Records and an executed copy of the Notice of Retention of Confidential Records. CA Alatorre subsequently requested a walk-through of the facility. SDA Tuddenham led CA Alatorre on a walkthrough of the facility. CA Alatorre inspected Licensee's resident rooms, medication room, saunas, recreational facilities, and locations wherein group therapy and one and one therapy are held. Licensee's facility was free of debris and clutter, items were stored neatly, and program participant file cabinets were locked.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _________ _

Prnoram/F.aclllt11 R.eare!!ientatlve

PAGE:

2 0118

STATE OF CALIFORNIA- HEALTH ANO HUMAN SERVICES AGENCY ADP 60HiL, RevlEed 01108

PROGRAM INVESTIGATIVE REPORT

Deparimenl of Alcohol and Drug Pro9ram:s Licensing :and Certlflc:allol"I Dlvl:Slori

1700 K Street, S~crarnenlo, CA 95811 TOO (916)4A5·1942, FOK('16) 322-2658

(916) 322-2911

PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-0500 REFE~ENCES; (1) Health and Safely Code Saetlon 116:S4.01 and California Code of Regulations (CCR), Title 9. Seclion 10502. Departrnenlal _Aut~orily to License.

(2) Health and Human Service!;> Agency, Department or Alcohol and Drug Programs, Alcohol and/or Olher Drug Program Certlf1cal1on S!andards.

CA Alatorre spoke with SDA Tuddenham concerning the purpose of the visit. SDA Tuddenham described the operations of the program, staff positions, and the services provided to Licensee's client and residents.

CA Alatorre conducted staff and resident interviews for the purpose of this investigation. CA Alatorre also requested and received medical records and documentation probative to the findings of this investigation. The California Department of Alcohol and Drug Programs ·maintains a copy of all documents referenced as the basis of a deficiency for the purposes of due process of law and other requirements as provided by statute.

Overview Licensee admitted Residen\#1 (Hereinafter "Decedent") to .Licensee's residential treatment program on

Decedent's first complaint of illness occurred on . . _ On • . _, Decedent requested to be transported to the emergency room where she was admitted. On ~ ---- Deceeent expired at the Intensive Care Unit located at

. _ , a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared by Dr. Steven Smith, M.D. as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.O. further noted that the Decedent suffered viral pneumonia for a sum of fourteen days prior to Decedent's expiration.

Detailed Chronological Manifest of Decedent's Illness On • . , a progress note was made my staff member (nursing assistant), Emma Thomas. Emma Thomas indicated that Decedent had "flu symptoms", "throwing up", "achy (sic.) body", "hot & cold chills, and sweats". Decedent's temperature was recorded at 101.6.

CA Alatorre did not locate a progress note for Decedent for

On, _ at 10:30AM, Emma Thomas documented in Decedent's residential chart, "Still has flu-symptoms-cold/hot chills, achey (sic.) body, cough". Decedent's temperature was recorded at 103 .1. A further notation was made "If fever continues to.rise possible ER".

On Jt 2:20 p.m. Emma Thomas documented in Decedent's residential chart, "T. 98.6, very sweaty, fever broke" and "continue resting. Will re-check around dinner".

CA Alatorre did not locate a progress not for Decedent for the recheck that was to occur on the evening of - -· ..,

On _. , .time not specified), Emma Thomas documented in Decedent's residential chart, "was doing good in AM, but is starling to feel worse again." Decedent's temperature was recorded at 99.9. Emma Thomas further records, "Will re-check in the PM".

I HAVE READ AND UNDER.STAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _________ _ '"'~---~-ic ... ,..111•., c,,..,.. ... &0 ... nf<>fi11~

PAGE:

3 cf 1B

STATE OF CALlfORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP Ei0151., RevlEied 01JOS


Departmenl of Alcohol and Otug Programs Licensing and Certlflcauan Division

1700 K Stree~ Sacramento, CA 9S:S,11 TDO (91Ei)44S-1942, Fax (91ti) 3:2.2~2658

(916) 322-2911

PROGRAM/FACILITY 10 NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN . Narconon of Northern California 10·0500 REFERENCES: (1) Health and Safely Code Section 11634.01 and California Code of Regulatlons (CCR), Title 9, SecUon 10502. DepartmenLa! ~ut~orlly Lo License.

. (2) Health and Human Services Ageney, Department of Alcohol and Drug Programs, Aleohol and/or Olher Drug Program Cert1f1eat1on Standards.

On July 28, 2009 at 11 :40 a.m., Re.gistered Nurse Christina Kuzio, RN/HCO (Registered Nurse/Health Care Officer) documented in Decedent's residential chart, "continues to feel sick, cough, chest discomfort, chills, Jappetite, body aches.", "Brought daily meds", and "Continue to rest- monitor temperature offer Urgent Care". Registered Nurse Christina Kuzio further reported, "Taking liquids not eating." Decedent's temperature was recorded at 103.2. · ·

CA Alatorre did not locate a progress note for Decedent for the recheck that was to occur on the evening of

Or • ~mma Thomas documented in Decedent's residential chart, "Last night ... temperature was at 103.6. Her [Decedent] bed sheets were covered in sweat and I could feel the heat coming off of her body. I insisted that she get into the bathtub full of luke-warm water to try and help bring her temperature down, and it would also make her feel better since she had not showered in three days. I had to assist her in doing this (getting into bathtub). I left her in the bath for about 10-15 minutes, whl/e I ran up to the linen closet and got new sheets. I re-made her bed, and then helped her get out of the bath tub. I gave her two tabs of Tylenol ... " " ... I got a dispatch from him {staff member Craig Schiavetta) saying that at 7:30am he checked [Redacted name of Decedent] temp and it was 103.9. I discussed going to ER with [Redacted name of Decedent] yesterday and she declined due to financial issues ... "

On~~., _". Jurse Practitioner Rebecca McKenzie diagnosed Decedent with a lower respiratory infection. Nurse Practitioner Rebecca McKenzie further documented in her . . ..• treatment report, "patient was educated to do deep breathing, "go to urgent care or ER if worsening". Decedent was prescribed a Zithromax 250MG regimen to. be taken two times on the first day and daily thereafter for a total of four days. Decedent's temperature was recorded at 100.7

Or • . between 1:40 p.m. and 2:10 p.m. Christina Kuzio, RN/HCO, documented in Decedent's residential chart, "dry cough persistent" and "Had 1•1 dose of Zithromicin". Decedent's temperature was recorded at 100.6.

On • Christina Kuzio, RN/HCO documented in Decedent's residential chart, "Last tyleno/ @ 725AM today was 100.2 by Craig", and that present temperature was "99. 7'. Christina Kuzio, RN/HCO further documented, " ... this is the longest she has gone without spiking high fever ... "and "This is the most alert/awake I have seen her'.

On Emma Thomas documented in Decedent's residential chart, " ... She [Decedent] refused to go to Urgent Care or the ER due to financial issue~ .... She was seen by Rebecca (in her room because she would not walk down to our office) .... She started antibiotics her fever has subsided and been at a normal temp for the past 2 days. I have been going down to her room since SaturdaJ " .. I told her since she has had a normal temp for past two days she would have to start coming down to my office to get her meds. She said she would no do this because she is in too much pain. She said all of the muscles in her body hurt from coughing. I am not sure what the next course of action should be with her,

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:----------PAGE:

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STATE OF CAl.lFORNIA-HE~TH AND i-lUMAN SERVICES AGENCY A.DP 601sL, Revised 0110s


Oep;iirtment of Aleohol ;1H1d Drug Programs Licensing ~nd Cerllfltalion Division

1700 K Slre~t. Sacramel"lto, CA 95811 iPD (916)445·1942, Fax (916) 322·26$8

(916)322-2911

PRQGRAMIFACll.lTY ID NUMBER,

1 PROGRAM/FACILITY NAME,

1

COMPl.AINT INVESTIGATION NUMBER,

440009CN . Narconon of Northern California 10-0500 REFERE.Nc1=s: (1) Health and Safety Cods Section 118:94.01 and Callforni~ Code or Regulations (CCR), Title 9, Secliot'l 10502. Depa.rtmen~_I .Aul~ority to License.

(.2) Health ~nd Human Services Aganey, Department of Alcohol and Drug Programs, Alcotiol and/or Other Drug Program Cerl.1f1callon Standards .

. as al/ medical options have been exhausted and she is constantly on HLO lines ... " /_.,-1

I , CA Alatorre again did not loca.te an ,it

;if .. ~

, regress note for Decedent.

On ._, Emma Thomas documented in Decedent's residential chart, "Today I went down to [Redacted name of Decedent]'s room to check on her and give her daily meds. As soon as I walked into the room told me that she couldn't breathe and that she wants to go to the hospital. I told her that I would have to arrange transporl,:fJnd I personally wouldn't be able to take her until the afternoon because Re/)ecca NP was coming tq see New Starts. [Redacted name of Decedent] told me she wanted to go ASAP. I told her I woutd1tif{,k to Ashly RSS and figure it out.../ went down to Ashly's office and told her what [Redacted name ot:Decedent] told me."

L* ' . On . u. , .. , ____ , Emrna Thomas documented in Decedent's residential chart, "last night I went to visit [Redacted name of De~dent] at the hospital to check on how she was doing. She was hooked up to two different /Vs, and looked very ill ... She told me that she had been really lonely since she has been in her room at the center alone for a week, and now she was alone in the hospital room .... / looked at the bags [Redacted name of Decedent] was hooked up to, I didn't recognize the name of one (if· was most likely an antibiotic) but the other one was potassium. {Redacted name of Decedent] told me that the doctors said her potassium levels were dangerously tow, and so were her blood oxygen cells, so they had her hooked up to an oxygen taken too ... [Redacted name of Decedent] did not natter or speak badly about Narconon for making her go on an LOA, and she did not say anything about us not taking action sooner to prevent her from getting pneumonia ... "

On , Decedent expired at .. -·- _ ... .,. - .

On , _ ·, a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as respiratory failure .which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the D~cedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration. · ·

On _ . a Narconon of Northern California discharge summary was signed by an unknown Narconon of Northern California Employee.

Staff Interviews concerning Decedent's Illness On ' · ·· ;A Alatorre presented prope(identification to SDA Tuddenham and informed SDA Tuddenham of the overall nature and purpose of CA Alatorre's visit.

CA Alatorre asked SDA Tuddenham about the practices and polices of the Narconon of Northern California Residential Program. SDA Tuddenham informed CA Alatorre that residents track their progress by the completion of books. There are a total of eight (8) books within the program. At book two (2), this is

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE; ~~~~~~~~~~

PAGE:

5 of18

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICl::S AGENCY APP 6015L, Revised 01/0B


Cc-p~nmcnt of Alcohol and brug Programs Licensing and C1:1rtlficc1Uon Plvlsl1;m

1100 I< Streel, Sacr.arnento, CA 9SS.11 TOO (916} ... 5·1942, Fox (916) 322·1658

(916)322-2911

PROGRAM/FACIL.ITY ID NUMBER: I PROGRAMIFACIUTY NAME: l COMPL.AINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-0500 REFE~ENCES: (1) Heallh and sarely Code Section 11S:34.01 and Callfornia Code of R.egulallons (CCR), Title 9, Sl!lction 1050.2. Departrnenial Aulhorlly lo License.

(2) Health and Human Services A~enc:y, Department of Alcohol ~nd Dru~ Programs, Alcohol li!nd/or Other Drug Program Cettifrcatlon Standard~.

when the students (residents) are integrated into the sauna portion of the program. A student cannot continue to the next book until they have completed book two unless medical conditions dictate they are ineligible to participate in that portion of the program. SDA Tuddenham confirmed Decedent was past book two of the program. Decedent's program and medical records confirmed Decedent was past book two and already successfully completed the sauna portion of the program ..

SDA Tuddenham subsequently introduced CA Alatorre to Registered Nurse Christina Kuzio prior to inspecting facility medications to audit compliance with California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10500 et seq. CA Alatorre inspected the medications located in Licensee's medication storage cabinet. All medications were properly labeled, stored, and corresponded with their respective centrally stored medication logs.

At approximately 1100 hours, CA Alatorre proceeded to ask Registered Nurse Christina Kuzio her recollection of the condition of the Decedent at Licensee's facility prior to the Decedent being transported to the local emergency hospital. At which time, Registered Nurse Christina Kuzio stated "I've been around Jong enough to know when I need to have representation and what I need to do to protect my license. I will not speak to you without representation present." At which time, CA Alatorre concluded the interview and continued to tour the facility. CA Alatorre advised SDA Tuddenham that CA Alatorre would not object to allowing Registered Nurse Christina Kuzio's legal representation be present during an interview, but CA Alatorre did need to ascertain what Registered Nurse Christina Kuzio's observations of the Decedent were in order to complete CA Alatorre's investigation.

At approximately 1600 hours, SDA Tuddenham informed CA Alatorre that Registered Nurse Christina Kuzio was willing to speak with her without legal counsel present. Registered Nurse Christina Kuzio stated that she did not initially understand the purpose of CA Alatorre's visit and where CA Alatorre was from. CA Alatorre advised Registered Nurse Christina Kuzio that CA Alatorre did not object to her having counsel present and her waiver of such was of Registered Nurse Christina Kuzio's own informed consent. Registered Nurse Christina Kuzio thereafter acknowledged CA Alatorre's statement and cooperated with CA's investigation and interview. CA Alatorre asked Registered Nurse Christina Kuzio what her recollection of Decedent was. Registered Nurse Christina Kuzio confirmed that she did recall Decedent and recalled that multiple advisements were provided to the Decedent that she should go to a hospital if she did not feel well. Registered Nurse Christina Kuzio relayed Decedent fervently refused as Decedent did not have health insurance which made it economically onerous for Decedent to seek treatment. Registered Nurse Christina Kuzio stated that the Decedent was closely monitored and was seen by a nurse practitioner that works with the program. Registered Nurse Christina Kuzio stated that the nurse practitioner had prescribed the Decedent prescription antibiotics and told the Decedent that if her condition worsened to go the emergency room. Registered Nurse Christina Kuzio further stated the death of the Decedent was "the only time something like this has happened". Registered Nurse Christina Kuzio and . .

SDA Tuddenham both acknowledged there was not a written policy concerning potential imminent illness and injury at the time of Decedent's expiration. CA Alatorre asked Registered Nurse Christina Kuzio if the Decedent was in the Sauna portion of her program. Registered Nurse Christina Kuzio confirmed the

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PL.EASE INITIAL. HERE: _________ .:_ PAGE:

6 of 1e

? •

STATE OF CALIFORNIA-HEALTH AND 11UMAN SERVICES AGENCY ADP 6015L, Revised 01108

OepartmQnl of Alcotiol and Orug Progti!l.ms Lleel"lslng ~nd Certification Division

1100 K Strest, Sacramento, CA 95811 TOO [916)445-1942, Fox (91•) 322-2656

(116) 322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California I

COMPLAINT INVESTIGATION NUMBER: 10-050D

REFERENCE:S; (1) He:E:ilth and Safety Code Saotion 11534.01 and Callrorni~ Code of Regulations (CCR), 'iilli! 9, Section 10502. Departmental AlJlhorlly to l..icense. (2) Health and Human Services Agency, Department of Alcohol and Drug F'rograms. Alcohol and/or Other Drug Program CerUflcatlon Standards.

Decedent was not in the Sauna portion and that the decedent was many books (steps) ·past that phase of the program. Registered Nurse Christina Kuzio confirmed that the nursing assistant, Emma Thomas, is no longer'employed at Narconon of Northern California.

1.

DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's death until one year after the death of Decedent.

REGULATORY AND/OR CERTIFICATION STANDARD REOUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10561, Reporting Requirernents provides, in part:

" ... (b) Upon the occurrence of any of the events identified in Section 10561 (b) (1) of this subchapter the licensee shall make a telephonic report to department licensing staff within one (1) working day. The telephonic report is to .be followed by a written report in accordance with Section 10561 (b} (2) of this subchapter to the department within seven (7) days of the event. If a report to local authorities exists which meets the requirements cited, a copy of such a report will suffice for the written report required by the department ... "

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, ' Article 2, §10561 (b)(1 )(A), provides such qualifying events include the, "(A) Death of any

resident from any cause."

SUMMARY: Licensee admitted Decedent to Licensee's residential treatment program on I Decedent's first complaint of illness occurred on _ , , Decedent requested and was transported to the emergency room where she was admitted. On,

, Decedent expired at the hospital intensive care unit. On i d certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration.

On August 12, 2010, Marie Montiero, Field Operations Branch Analyst with the Department of Alcohol and Drug Programs (ADP), contacted Jeff Panelli, Senior Director of Administration at Narconon of Northern California (Hereinafter "SDA Panelli"), to inquire about Decedent's death.

SDA Panelli told Ms. Montiero that there was a death at the facility; however it was over a year ago. SDA Panelli further stated that because the death did not happen at the facility, it was not renorted to ADP.

I HAVE READ AND UNDERSTAND THE ASOVE INFORMATION. PLEASE INITIAL HERE; _________ _ PAGE: 1 or1a

P.toaram/Facililv Reoresentative

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01,oa

Department of Alcohol and Oru9 Programs L.ieenslng and Certlflca.Uon Division

1700 I( Street, Sacramanlo, CA 95811 TDD (916) 445-1942, Fax (916) »N•SS

(916)322-2811

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PRO(iRAM/FACILITY NAME: 440009CN Narconon of Northern California I

COMPLAINT INVESTIGATION NUMBER: 10-0500

REFERENCES; (1) Heallh and Saf!;!lY Code Sec\iOf'l 118:S4.01 and California Code of Regulations (CCR), Tille 9, Seeliori 10502. Department:;il Authorlly lo Ucen:se. (2) Health and Human Ser11lces Agency, Department of Alcohol and Drug Programs, Aleohol and/or Other Drug Program Certification S!andards.

2.

Based on the findings, the Licensee failed to make a telephonic report to ADP staff within one (1) working day of Decedent's death. Thus Licensee is noncom pliant with California Code of Reoulations ICCR), Title 9, Division 4, Chaoter 5, Subchaoter 3, Article 2, l:;10561. DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did ·not notify the Department of Alcohol and Drug Programs of Decedent's death until one year after the death of Decedent.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10561, Reporting Requirements provides, in part:

" ... (b) Upon the occurrence of any of the events identified in Section 10561 (b) (1) of this subchapter the licensee shall make a telephonic report to department licensing staff within one (1) working day. The telephonic report is lo be followed by a written report in accordance with Section 10561 (b) (2) of this subchapter to the department within seven (7) days of the event. If a report to local authorities exists which meets the requirements cited, a copy of such a report will suffice for the written report required by the department ... "

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10561 (b)(1)(A), provides such qualifying events include the, "(A) Death of any resident from any cause."

SUMMARY Licensee admitted Decedent to Licensee's residential treatment program on I Decedent's first complaint of illness occurred on Decedent requested and was transported to the emergency room where she was admitted. On f _. . Decedent expired at the hospital intensive care unit. On J . , certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration.

On ~ .v1arie Montiero, Field Operations Branch Analyst (Hereinafter "FOB Analyst Montero") with the Department of Alcohol and Drug Programs, contacted Jeff Panelli, Senior Director of Administration at Narconon of Northern California (Hereinafter "SDA Panelli"). to inquire about Decedent's death.

SDA Panelli told FOB Analyst Montiero that there was a death at the facility; however it was over a year ago. SDA Panelli further stated that because the death did not happen at the facilitv, it was not reoorted to ADP.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE; _________ _ PAGE;

8 of ,a

STATE OF CALIFORNIA-HEALTH ANQ HUMAN SERVICES AGENCY ADP 601.5L, Revised. 01/08

Cop;u1mcnt of Alcohol and Drug Programs Licensing i!lnd Certlficallon Division

1700 K Street1 Sacramento, CA 95811 TOO (916) 445-1942, Fo, (916) 322-2658

(916) 322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME; 440009CN Narconon of Northern California I


Rl:::Fl::R.ENCES: (1) Health end Safely Code Section 11834.01 and California Code of Regulations (CCR.}, TiUe 9, Section 10502. Departmental Authorily lo License. (2) Heallh and Human Services Agency, Depanment of Alcohol and Orug f:lrogr.ams, Alcohol andlor Other Drug Program Cerljfication Standards.

On or about RAS.

, Licensee sent the death incident report signed by Scott Friend,

Based on the findings, the Licensee failed to send a written report in accordance with Section 10561 (b) (2) of this subchapter to the department within seven (7) days of Decedent's death. Thus Licensee is noncompliant with California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10561.

DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did not possess policies and procedures ensuring Decedent sought timely medical treatment

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENTIS): The Alcohol and/or Other Drug Program Certification Standards, Health Questionnaire, § 12055 provides:

'If during the course of recovery or treatment services, the participant Is PJssessed and determined to be in need of additionc1l services, the program shall provide the pc1rticipant with a referral to the appropriate services, if available. The program shall maintain and make avai/c1ble to participants " current list of resources within the community that offer services thc1t are not provided within the program. At a minimum, the list of resou"es shall include medical, dental, mental health, public health, social services and where to c1pply for the determination of eligibility for State, federal, or county entitlement programs. Program policies and procedures shall identify the conditions under which referrals are made. For each participant for whom a referrai'is made, an entry shali be made In the participant's file, documenting the procedure for making and following-up the referral, and the agency to which the referral was made."

The Alcohol and/or Other Drug Program Certification Standards, Referral For Medical or Psychiatric Evaluation and Emergency Services,§ 12050 provides: "The program shall have written procedures for obtaining medical or psychiatric evaluation and emergency services. All program staff having direct contact with participants shall, within the first year of

3. employment, be trained in infectious disease recognition, crisis intervention referrals and to recognize physical and psychiatric symptoms that require appropriate referrals to other agencies."

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10563 provides: "The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation."

SUMMARY:

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:-----~----PAGE:

9 of 18

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 601 SL, Revised 01/08

bepartment of Alcohol and Dtug Programs Licensing ancl Certification Dlvl$.lon

1700 K Street, Sacr.1;1,mento, CA 95811 TDD (916) 445-1942, Fox (916)322-265'

(916) 322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAMIFACII.ITY NAME: 440009CN Narconon of Northern California I


REFERENCES: (1) Health and Sei1ety Cocre Secllon 111334.01 c1nd California Code of Regi.rl.etions (CCR), Title 9, Section 10502. Departmenlal Avltiori1y 1o License. (2) Health :and Human Services Agency, Department of Alcohol and Drug Pro~rams~ AICohol and/or 0\hl:lr Drug F'ro9tam Certification Sl:anderds.

4.

Registered Nurse Christina Kuzio confirmed that she did r.ecall Decedent and recalled that multiple advisements were provided to the Decedent that she should go to a hospital if she did not feel well. Registered Nurse Christina Kuzio relayed Decedent fervently refused as she did not have health insurance which made it economically onerous for her to seek treatment. Registered Nurse Christina Kuzio stated that the Decedent was closely monitored and was seen by a nurse practitioner that works with the program. Registered Nurse Christina Kuzio stated that the nurse practitioner had prescribed the Decedent prescription antibiotics and told the Decedent that if her condition worsened to go the emergency room. Registered Nurse Christina Kuzio further stated that the death of the Decedent was the only time something like this has happened. Registered Nurse Christina Kuzio and SDA Tuddenham both acknowledged there was not a written policy concerning potential imminent illness and injury at the time of Decedent's expiration. CA Alatorre asked Registered Nurse Christina Kuzio if the Decedent was in the Sauna portion of her program. Registered Nurse Christina Kuzio confirmed the Decedent was not in the Sauna portion and that the decedent was many books (steps) past that phase of the program. Registered Nurse Christina Kuzio confirmed that the nursing assistant, Emma Thomas, is no longer employed at Narconon of Northern California.

Based upon the interviews of Registered Nurse Christina Kuzio and SDA Tudddenham, Licensee did not maintain a resident medication log for the Decedent. The Licensee is noncom pliant with Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10563, Alcohol and/or Other Drug Program Certification Standards §12050, and Alcohol and/or Other Drug Program Certification Standards §12053.

DESCRIPTION OF THE DEFICIENCY: "CLASS B" Licensee provided an inaccurate statement to the Department of Alcohol and Drug Programs.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subehapter 3, Article 2, §10510, Prohibition against False.Claims Regarding Licensure, provides: "No licensee, officer, or employee of a licensee shall make or disseminate any false or misleading statement regarding licensure of the facility or any of the services provided by the facility."

On August 12, 2010, Marie Montiero, Field Operations Branch Analyst (Hereinafter "FOB Analyst Montero") with the Department of Alcohol and Drug Programs, contacted Jeff Panelli, Senior Director of Administration at Narconon of Northern California (Hereinafter "SDA Panelli"), to inquire about Decedent's death.

SDA Panelli told FOB Analyst Montiero that there was a death at the facility; however it was over a year ago. SDA Panelli further stated that because the death did not happen at the facility, it was not reported to ADP.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _________ _ PAGE:

10 of 18

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY AOP 601SL, Revised 01108

Dep:rtmerit of Alcohol and Orug Progr:ams Licensing and CertHlc.ation Division

1700 K Street, Sact21me1110, CA 9Sfl11 TDD (916) 4-45-19'2, Fa,(916) 322·2658

(916)322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY 10 NUMBER: I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California I


REFER!:;:NCES: (1) Hea.lth and Safety Code Section 11SS4.01 and California Code of Re~ulations (CCR), Tille 9, Section 1050-Z. Oepartml!:ntal AuthoriLyto l.icens@:. (2) Heallh and Human Services Agency, Department of Alcohol and Drug Progrems, Alcohol and/or Other Drug Program Certmc:.auon Standards.

4.

On or about . _icensee sent the death incident report signed by Scott Friend, RAS. The report was dually executed by Program Director Daniel Manson CCDC, RAS.

Scott Friend, RAS, represented to the department on the unusual incident/injury/death report form, " Was given options to be transported to ER or D/C'd on medical leave.

: Seen by ER staff and admitted for pneumonia"

CA reviewed the I report of staff member Emma Thomas concerning Decedent's condition which stated, "Today I went down to [Redacted name of Decedent] to check on her and give her daily meds. As soon as I walked into the room told me that she couldn't breathe and that she wants to go to the hospital. I told her that I would have to arrange transport, and I personally wouldn't be able to take her until the afternoon because Rebecca NP was coming to see New Starts. [Redacted name of Decedent] told me she wanted to go ASAP. I told her I would talk to Ashly RSS and figure it out .... I went down to Ashly's office and told her what {Redacted name of Decedent] told me."

Accordingly, it does not appear from the record that Decedent was provided an ultimatum of go to the emergency room or you will be discharged. It appears Decedent, from her own volition and without any advisement, requested to be transported to the emergency room immediately.

Based on the review of Licensee's Jnusual Incident/Injury/Death Report form and the report of staff member Emma Thomas concerning Decedent's condition Licensee is noncompliant of California Cocfe of Regulations (CCR), Title 9, Division 4, Chapter 5, Subthapter 3, Article 2, §10510. ·

DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did not ensure Decedent was afforded safe, healthful and comfortable accommodations to meet Decedent's needs.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10569, Personal Rights provides: "(a) Each resident shall have personal rights which include, but are not limited to, the following: ... (3) To be accorded safe, healthful and comfortable accommodations to meet his or her needs ... "

SUMMARY: CA Alatorre reviewed the Decedent's chart and all materials gathered during the course of the investigati.on. CA Alatorre reviewed the . , 1art note of Emma Thomas.

On mma Thomas documented in Decedent's residential chart, "Last

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE'---~------PAGE:

11 of 18

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP ti015L, Revl:sed 01/08

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER; I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California

Dep;artment of Alcohol .zind Orus Programs Licensing .and Cenrfication Division

1700 K Strtct, S;acr.artiel"lto, CA 95811 TDD (016) 4'5·19!2, Fox {916) 322"2658

(916) 322·2911

I COMPLAINT INVESTIGATION NUMBER: 10-0500

REFERENCES: (1) Heallh and Safety Code Sec1ion 111334.01 and California Code of Regula lions (CCR.), Tltle 9, Section 10502. DepartrnenWI ALllhorityto Lloense. (2) Health and Human Services Agency, Oeparlrnent of Alcohol and Drug Programs, Alcohol and/or Olher Drug Program CerUllcalion Standards.

night...temperature was at 103.6. Her [Decedent] bed sheets were covered in sweat and I could feel the heat coming off of her body. I insisted that she get into the bathtub full of lukewarm water to try and help bring her temperature down, and it would also make her feel better since she had not showered in three days. I had to assist her in doing this (getting into bathtub). I left her in the bath for about 10-15 minutes, while I ran up to the linen closet and got new sheets. I re-made her bed, and then helped her get out of the bath tub. I gave her two tabs of Tylenol ... " " ... I got a dispatch from him [staff member Craig Schiavetta] saying that at 7:30am he checked Ilene's temp and it was 103.9. I discussed going to ER with [Redacted name of Decedent]yesterday and she declined due to financial issues ... "

On . , Decedent requested and was transported to the emergency room where she was admitted. On _ . . Oecedent expired at the hospital intensive care unit. On _ , a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was c;leclared as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration.

Decedent had the right to be accorded safe, healthful, and comfortable accommodations to meet her needs. The .:;hart note prepared by Emma Thomas reflects Decedent was so weak; she could not even make it to the bathroom tub unassisted. Further chart notes by Emma Thomas and Registered Nurse Christina Kuzio reflect that Decedent was so weak that from · to her admittance in the hospital emergency room on . _ . she could not even retrieve her fever and pain reducing medications at the nurse's station on site at Licensee's facility.

Based on: 1. Review of Decedent's Chart 2. Interview of SDA Tuddenham; 3. Interview of Registered Nurse Christina Kuzio; and, 4. Decedent's death certificate;

Licensee Is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10569 (a) (3) .

DESCRIPTION OF THE DEFICIENCY: "CLASS B" Licensee staff did not complete the required Resident Health Screening for Decedent.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT($): Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10567(a) provides: "(a) Every resident shall complete a health questionnaire which shall identify any health problems or conditions which require medical attention, or which are of such a serious nature

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:----------PAGE;

12 of 18

' STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY AOP 6015L, Revised 01108

Oep.1;1rtm&hL of Alcotiol and 1Jr1,1g J:l'rograms Llecnslng .1;1rid c1:1nlfleatlon Olvl:siori

1700 K Street, Saeramento, CA 95811 TOD (916) 445.1942, Fax (916) 322-2658

(916)322·2911


COMPLAINT INVESTIGATION NUt:ABER:

10"0500 REFERENCES; (1) Health and Safety Code Sectiori 11534.01 and California Code of Regulations (CCR), Title 9, Secllon 10502. Depsrtmental Authorlly to License.

(2) Hea!lh and Human Services Agency, Oepanmeni of Alcohol and Drug Program~. Alcohol :and/or Other Drug Program Cer1lflcallon Standards.

as to preclude the person from participating in the program."

5. . Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10567(c)(1 ) provides: " . .. (c) Licensee's staff shall carefully review each resident's health questionnaire, interview each resident regarding information given, and ensure that:(1) A resident seeks and obtains medical or dental assistance for any significant health problems while remaining in residency; or (2) Be referred to an appropriate facility which can provide required service."

The Alcohol and/or Other Drug Program Certification Standards, Health Questionnaire, 12020, provides:

'The health questionnaire, shall be completed for all participants admitted for residential or nonresidential alcohol and/or other drug services. Programs may use form ADP 10100-A-E for the health questionnaire or may develop their own health questionnaire provided it contains, at a minimum, the information requested in ADP 10100-A-E. The health questionnaire is a participant's self-assessment of his/her current health status. The health questionnaire shall be completed and signed prior to the participant's admission to the program and filed in the participant's file.

Program staff shall review each completed health questionnaire. When appropriate, the participant shall be referred to licensed medical professionals for physical and laboratory examinations. A medical clearance or release shall be obtained prior to admission whenever a participant is referred to licensed medical professionals for physical and laboratory examinations. The referral and clearance shall be documented in the participant's file."

The Alcohol and/or Other Drug Program Certification Standards, Participants Files 17015(b)(2)(E) provides, " . .. b. At a minimum, each participant file shall contain the · following ... 2. Admission and Intake Data; ... A/1 data gathered during admission and intake including: .. .E. Health questionnaire;"

SUMMARY: CA Alatorre reviewed the Decedent's chart and all materials gathered during the course of the investigation. Licensee admitted Decedent to Licensee's residential treatment program on

and again on CA Alatorre did not locate a health questionnaire for Decedent's admittance date on · .... _ _ _, __ _ Jn ' .A Alatorre requested the health questionnaire from SDA Tuddenham, SDA Tuddenham responded that Licensee did not possess another health questionnaire because Decedent was not ever discharged, but merely transferred to the Licensee's sister facility. SDA Tuddenham stated that a health questionnaire however was completed at the South Lake Tahoe facility (Licensee's sister facility).

Based on:

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _________ _ PAGE:

13 of 18

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY APP 6015L, Revised 01/08

Department or Alc::ohol and Drug Programs Licensing and Certlficetlon Division

1700 K Streel, Sacramehto, CA 95811 TPO (91Ei) 445,1942, Fat (91~) 322-2658

(916P22-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY 10 NUMBER: I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California I


REFERENCES: (1) Health and Safety Code Section 11834.01 and California Code of Regul~tions (CCR.), Tlile 9, Secllon 10502. Departmental Aull"lorilyto License. (2) Health and Human Services Agency, Depal'tment of Alcohol and Drug Programs, Alcohol and/or Other Drug Proi;:iram CertiflcaUon Standards.

1. Review of Decedent's Chart; 2. Review of Decedent's ' admission agreement"; 3. Interview of SDA Tuddenham;

Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §§10567 (a) and 10567 (c).(1), (3), The Alcohol and/or Other Drug Program Certification Standards§§ 12020 and 17015 (b)(2)(E).

DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did not ensure its counseling staff was licensed, certified, or registered six months from date of hire.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §13010 (a), REQUIREMENT FOR CERTIFICATION, provides: "(a) By April 1, 2010, at least thirty percent (30%) of staff providing counseling services in all AOD programs shall be licensed or certified pursuant to the requirements of this Chapter. All other counseling staff shall be registered pursuant to Section 13035(f)."

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §13005 (4) (A)(B)(C)(D)(F) Definitions provides:

"'Counseling services' means any of the following activities: (A) Evaluating participants', patients', or residents' AOD treatment or recovery needs, including screening prior to admission, intake, and assessment of need for services at the time of admission; (B) Developing and updating of a treatment or recovery plan; (C) Implementing the treatment or recovery plan; (0) Continuing assessment and treatment planning; (F) Documenting counseling activities, assessment, treatment and recovery planning, clinical reports related to treatment provided, progress notes, discharge summaries, and all other client related data."

6. California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 1"0563, provides: "The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation."

SUMMARY: CA Alatorre randomly reviewed Licensee's personnel files to audit compliance with California Code of Regulations, Title 9, Chapter 5, Subsection 2, §10500, et seq.

Upon review of Licensee's files, CA Alatorre observed staff member Dylan Chatterton's personnel file. Dylan Chatterton signed the Narconon of Northern California Job Description for "Course Supervisor" on December 8, 2010. In the iob descriDtion, it soecified that Dvlan

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _____ ..;.... ___ _ PAGE:

14of1S·

STATE OF CALIFORNIA - HEAi, TH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01/08

Dei:i~rtmenl cf Alcohol and Drug l=>rograms L.letnslng :imd Certlflci:1.llon Oi1Jislon

1700 K Street, Sac:r~menlo, CA 95S11 TDD (916)445-1942, Fax (916) 322-2658

(916) 322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FAClllTY ID NUMBER: I PROGRAM/FAClllTY NAME: 440009CN Narconon of Northern California I

COMPlAINT INVESTIGATION NUMBER:

10-050D RE:~ERENCES: (1) Health and Safety Code Seclion 11834.01 end C:aliforni~ Code of Regulations (CCR). TILie 9, Section 10502. Oepartml!lntal Aulhority lo License.

(2) Health and Human Ser'.'lces Agency, Department of Alcohol and Drug Prograrn:s, Alcohol and/or Other Drug Program Certification Standards.

Chatterton's position " .. . oversees and helps each student on the section of the program that are done in the Course Room. The Course Supervisor is there to see that the student fully gets and can apply what he/she has studied." CA Alatorre also reviewed another job description signed by Dylan Chadderton on March 20, 2011. In the job description, it again specified that Dylon Chatterton's position is, "Responsible for supervision of NN Program Course Room and running it standardly. This includes helping each student working in the course room successfully complete the course that they are on. He/she is ultimately responsible for the student's knowledge and application of what they have studied." The program required that the supervisor "Must be registered as a Registered Addiction Specialist Intern (RASi) within 6 months of initial hiring" and "Must attain certification as a RAS within 5 years of registered as a RASi".

CA Alatorre asked SDA Tuddenham where Dylan Chadderton's RAS certification or registration was. SDA Tuddenham confirmed Dylan Chadderton was not licensed, certified, or registered to perform alcohol or other drug treatment counseling services.

Based on the following evidence: 1. Review of Dylan Chadderton's Personnel File; 2. Interview of SDA Tuddenham;

Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §§ 13010(a) and 13563.

DESCRIPTION OF DEFICIENCY: "CLASS B" Licensee failed to ensure personnel are tested for Tuberculosis annually.

REGULATORY REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10564 (c) (1), Personnel Requirements, provides

"All personnel shall be in good health ... good physical health shall be verified by a health screening, including a test for tuberculosis, performed under licensed medical supervision not

7. more than 60 days prior to or 7 days after employment with tuberculosis testing renewable every year .... "

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article § 10565 (b) Personnel Records provides " ... All personnel shall have on file the record of the health screening as specified in section (c)(1), (2) of this subchapter ... "

SUMMARY:

111 HAVE READ AND UNDE,RSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:_~----------••----,,,-, .. -~-._-_-__ -__ -,.-.,-... - I PAGE:

15 of 1B II

STATE OF CALIFORNIA-HEALTH ANO HUMAN SERVICES AGENCY ADP 6015L1 Revised 01/08

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME; 440009CN Narconon of Northern California

DepartMel"lt of Alcohol and Orug ProgramS Llcens.lng a!"ld Certification Division

1700 K street, Sacramento, CA gsa11 TCC (~16)445-1942, Fax (916) 322·2ti5S

(916)32.-2911

I COMPLAINT INVESTIGATION NUMBER:

10-0500 RE~ERENCES: (1) Health and Safely Code Si!etlon 11834.01 i;ind Californis Coda of Regulations (CCR), Tille 9, Section 10502. Depanmenlal Aulhorityto License.

(2) Heallh and Human Servi~s Agency, Departrnent of Alcohol and Drug Progrsms, Alcohol andfor Other Drug Pro~ram Certificalion Standards.

CA Alatorre randomly reviewed Licensee's personnel files to audit compliance with California Code of Regulations, Title 9, Chapter 5, Subsection 2, §10500, et seq.

Upon review of Licensee's files, CA Alatorre observed staff member Alyssa Gosselin's personnel file. Alyssa Gosselin's personnel file reflects that Alyssa Gosselin's first tuberculosis test was conducted on , 2009. Alyssa Gosselins next tuberculosis screening was conducted one year and one month later (13 months later) on October 13, 2010.

Based on review of employee Alyssa Gosselin's personnel file, Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10564(c) (1 ).

NOTICI; OF DEFICIENCY - It Is lmportant that the. licensee complies with regulations and the instructions of this .Notice of Deficiency. F.ailure of tbe {icensee to comply may result in other possible enforcement actions, such as license suspension orrevocation. .

NOTICE Of DEFICIENCY (FOR VIOlATclON OF GCR, TITLE 9, CHAPTER 5 SECTION 10500 et seq. - The licensee shall submit written verification .of po.rrectio9 for the.Class A deficienc.Y(ies) identified in this notice of'!!feficiency to ADP within 10 days of receipt of lhe :nbtiqe of deficiem;y. Th~i" written .. verification shall substaritlate that the deficiency(iEi's) have been wtiected and specify the dale When· the deficiency(les) were corrected. If tile licensee cannpt ,;c>lTect.thi:H:lefieiency(ie~) Within 10 tlay.s .of . receipt of this notice, the licensee shall :submit a written Correttive, Action Plan '{CAP} to: Manager, Program Compliance eranch, Department ·of Afoohbl and ;l)l'(Jg·P~,i!rams, liclm$1ng and <;ertificalion Division, 17-0() K Street, Sacramento, CA 9581 h41J$7. Th,e CAP, stll;l11 include what steps the licensee lias taken to torrect the deficiericy(ies); substantla~e why \bl:! defieiencY(les) ~rinot :be corrected as specified in this notice; and specify when the deficiency will :be oomected. The wr.itten verification of correction otwriften CAP shall be postmarke~ no laterl~an/thed~taj'.:s):specifjed in thiS'notice. Ttle . licensee shall submit .written verification of c;;oire,ctll!ihfor.lh.!:) 'Cla:Sf:,3 and c deficlency(ies) :identified in this notice ofdeficlency to ADP within 30 da!{S pf 'retjiipt :ofith!:! notl~,of~Efi~lency. If the licensee. cannot correct the deficiency{iel?) within 30 day.s:m rewfp(of'tpis::riptice;the 1i~nsee shall Submit a written Correptiv.e Actim:i Plari (CAP) to:. tv'lan~~er, ,~r9gram;Cot$li~nt;eBtatjch, Department of Alcohol and Drug Programs, licensing and CertificatiOl'i l)ivjs\ori, 1700 K Str.e¢f, :S~cramento, CA 9581'14037 .. The CAP shall include what steps the licensee has taken to ciirrf:ictthe deficiency(ies): s'ubstariliate Why the deficiericy(ies) cannot be corrected as specified 1n this n'otice; atjd specify wheh the deficiency will be corrected. The written verification of correction or written CA.P shall be postmarked no later than the date(s) specified iri this notice. · · · · ·

Penaltv: Fallure to correct the above cited deficlencvfies) shall result in the assessment of a civil

II I HAVE REAO AND UNOERSTANO THE ASOVE INFORMATION. Pl:EASE INITIAL HERE: _________ _ PAGE:

16 of18

STATE OF CALIFORNIA - HEAL TH ANO HUMAN SERVICES AGENCY AOF' 6015L. Revised 01/08

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY 10 NUMSC:R: I PROGRAM/FAClllTY NAME: 440009CN Narconon of Northern California

Oepnrtment of Alcotiol and Drug Programs Llcen:sinQ and Cl!lrtlflcat1on Division

1700 K Sltect. Sacramento, CA 95811 TOO (916)445-1942, fax(916) 322,265"

(916) 322-2911

I COMPlAINT INVESTIGATION NUMBER: 10-0500

Rl=fERENCES; (1) Health and Sa1ety Code Section 11a34.01 end Calirorl'liS Code of Regulations (CCR), Tille 9, Seolion 1050.2. Departmental Aulhoril~ to License. (2) Health and Human Services Agency, Department or Alcohol and Drug Programs, Alcohol and/or Other Drug ?rogram Certifiealion Standards.

penalty of $50 per day .for each Class A deficlency1 beginniR9 oi"I the 11"' day .after receiving this notice and will continue to accrue until the date the licensee submits verification that the deficiency(les) are corrected or until the date a written CAP is <eceived and approved. The date -of submisslonby the licensee of the written verification of correction, or the wrJtteri CAP, slfall be :the rlatel"that it is postmarked. The m:!:!ximum daily civil penalty for the .dEifi.Cjency{les) shall not exceed one ht1ndred and fifty dollars ($150) per .day. . . . • . . .. . . . . . . Failure to correct the above cited deficiency(ies) shall resu1Un the assessment of a civil penalty of $50 per day for each Class B deficiency(ies )and $25 per day for each Class C deficiency(ies), beginning on the 31$1 day .after receiving this notlce and will continue to:a!Xiue until th\3 date the 1icensee submits verification that the deficiency(ies) .are corrected 6r until 'the 'liate ,? writt~ CAP is received and approved. The date ofsubmission by the licensee ofthi;l written verlfication of correction. or the written CAP, shallbe the date that it is postmarked. The ma>timumdaily clvil·penaltyfodhe'deficiency(ies) shall not exceed one hundred and fiftvdollars ($150l per<Jav •.

PROGRAM INVESTIGATIVE REPORT SUPPLEMENTARY INFORMATION

IT IS IMPORTANT THAT THE PROGRAM/FACILITY COMPLY WITH THE CALIFORNIA CODE OF REGULATIONS (CCR\, TITLE 9.

• *

NOTICE OF DEFICIENCY - Title 9, Chapter 5, Sections 10543 & 10544, of the California Code of Regulations (CCR), requires the Department complaint investigator/reviewer to prepare a written NOD at the completion of each complaint investigation/licensing compliance review listing all deficiencies noted. The NOD is made a part of the licensing records for the facility and the licensing agency, and is available for public review. Care is taken not to disclose any confidential information in the report. Inquiries concerning the location, maintenance, and content of these reports,may be directed to the Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814-4037.

DEFICIENCIES - A deficiency is a failure to comply with any provision of the regulations pursuant to Chapter 7.5 of Part 2 of Division 10.5 of the Health and Safety Code. The NOD shall specify: the section number, title, and code of each statute or regulation which has been violated; the manner in which the licensee has failed to comply with a specified statute or regulation, and the particular place or area of the facility in which ii occurred; the date by which each deficiency shall be corrected; amount of the civil penalty to be assessed in accordance with Title 9, Chapter 5, Sections 10547, CCR, and the date the Department shall begin to assess the penalty, if the licensee fails to correct the noticed deficiencies or submit a CAP.

WRITTEN NOTIFICATION TO DEPARTMENT - The licensee shall submit to the Department written verification of correction for each deficiency identified in this notice of deficiency (NOD). The written verification shall substantiate that the deficiency has been corrected and specify the date when the

I HAVE READ AND UNOE'RSTAND THE ABOVE INFORMATION. PlEASE INITIAL HERE: _________ _

PrograrnfFaelllty Representative

PAGE: 17 of 1a

_ _j_ _____ _.,

STATE OF CALIFORNIA~ HEALTH ANb HUMAN SERVICES AGENCY ADP ti01Sl., Revised 01JCIB

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY II) NUMBER; I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California

Department of Alc:ohol and Orug Programs Llcen:Eilng :and Ccrtlrlc~tion biVi!;i:lon

1700 K Slrec1, Sacrilimento, CA. 95811 TOO (916) '45·1942, Fax (916) 322-26.S

(916)322-2911

I COMPLAINT INVESTIGATION NUMBER; 10-0500 ·

REFERENCES: (1) Health arid S;;ifety Cod~ Sec.lion 11634.01 end Calffornia Code of Regulatlons (CCR.), Tille 9, Seclion 10502. oepanmenlet Authority to Licen:se. (2) Health and Human Services Agenoy, Depar\ml:!nt or Alcohol and DrLlg Programs, Alcohol .and/or Other Drug Program Cenmeatlon Standards.

deficiency was corrected. If the licensee cannot correct a deficiency within the days specified in this NOD, the licensee shall submit a written CAP to: Manager, Programs Compliance Branch, Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814. The CAP shall include what steps the licensee has taken to correct the deficiency (ies); substantiate why

the deficiency cannot be corrected as specified in this NOD; and indicate the specific date when the deficiency (ies) will be corrected. The written verificaUon of correction or written CAP shall be postmarked no later than the date specified in this NOD. ·

CLASS A DEFICIENCIES - Due to the imminent danger to residents, Class A deficiencies must be abated or eliminated immediately. An immediate civil penalty of fifty dollars ($50) is assessed against the licensee upon the discovery of each Class A deficiency described in this NOD. The civil penalty will continue to accrue until the licensee submits verification that each deficiency is corrected. Failure of the licensee to comply may result in other possible enforcement actions, such as license suspension or revocation.

CLASS B DEFICIENCIES - Due to the potential danger of the health and safety of residents, the time period to correct the Class B deficiencies may be less than thirty (30) days if the reviewer determines the deficiency is sufficiently serious to require correction within a shorter period of time.

ALL OTHER DEFICIENCIES - The licensee shall submit to the Department written verification of correction for each deficieni;:y identified in this NOD within thirty (30) days of receiving this NOD. Failure to correct the deficiencies described in this NOD by the date specified shall result in the assessment of a civil penalty of fifty dollars ($50) per day for each Class B defic1ency and twenty-five dollars ($25) per day for each Class C deficiency, beginQing on the 31st day after the receipt of this NOD and will continue to accrue until the date the licensee submits verification that all deficiencies are corrected or until the date a written CAP is received and approved by the Department. The date of submission by the licensee of the written verification of correction by the licensee shall be the date it is postmarked. The maximum daily civil penalty for all deficiencies shall not exceed one hundred and fifty dollars ($150) per day.

CORRECTIVE ACTION PLAN (CAP)- Title 9, Chapter 5, Section 10545, CCR, allows the licensee to submit a CAP for those Class B or C deficiencies which cannot be corrected by the date specified in the NOD. The licensee shall send a written CAP addressed to the Manager of the Programs Compliance Branch, Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814-4037, postmarked no later than the date specified in the NOD. The written CAP shall include: what steps the licensee has taken to correct the deficiency; substantiate why the deficiency cannot be corrected by the date specified in the NOD; and specify when the deficiency will be corrected. Within ten (10) days of receipt of the CAP, the Department shall notify the licensee, in writing by first class mail, whether the CAP has been approved.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _________ _

Program/Facility Representative

PAGE:

16 of 18

0 • COMMUNICATIONS CLEARANCE

SECTION I. P~Qe 1 of j DATE: l;.::1\ / (fll~0.ll Originator/Author ·- I

FROM: SUBJECT: NAME:

Adrianna A. Alatorre PROVIDER NAME: ~t,J.)tJ d-'t\\".::ekh.Q.h\l'l CA OIVla,10Nl!!RAl>lw, ;

LCD I PCB rm.<NE:

PROVIDER NUMBER: (916) 445"9153

PURPOSE (BE BRIEF): ACTION REQUESTED: O SIMlJLTANEOOS R~\IIEW

INITIAL LJCENSE/CERllFICATION 0 181 Sign

0 RENEWAL LICEt(SEICERTIFICAllON

181 Review/Comment OTHER. l81

DUE DATE:

CONTROL NUMBER: t'\R .wsvusv~ a APR<OV~u SECTION II. Orh::rinator must route to all .afffcted ,partle$ b&fore Sendin.a to DJrector',s Office.

REVIEWER'S ROUTING DESIGNATEO 1NITfAL.$ OATE , .. ,-

~1111-r -""' (; -~ a- 1-1 (:2

1. Janelle lto-Orille ',)

2. Adrianna Alatorre ( 7r rl ~ \'a ..........

3.

4.

5.

6.

7.

8 .

. 9.

10.

MAILED: SECTION Ill. l>lSTAIBUTION

Tills document to tiedlsll"ibl.lled: n3'r.ANbARo u.s. MAIL i1,lr'lt£RA13~NCYMAtt. nm•swfm,tT(! n1Nr~lo,1;s11;11;'.AIJP) ~~IL r1,FAX no\ll!Ri.JIGH'l'MAIL

COMMENTS (FILEPATH):

SECTION IV. FINAL APPROVALS: (Signature & Date) D URGEl\!i DEPUTY DIRECTOR DATE

Please call for pick-up:

CHIEF DEPUTY DIRECTOR DATE NAME:

DIRECTOR DATE PHONE:

'

~iit~y:Sp;;irJ(~ . ·•· From: Sunny Langley Sent: Wednesday, October 20, 2010 8;53 AM To: Corey Sparks Subject: FW: Caller w Information about Death

Importance: High

The c.iller did not give his name and did not want to go to the complaint intake coordinator. I took as much information as he would provide and gave him complaint Information should he wish to make a complaint or wanted to encourage the family to make a complaint. Thank you, Sunny

From~ Sent: To: Cc: Subject: Importance:

Manuel Vasquez Wednesday, October 20, 2010 8:23 AM Sunny Langley Chris Lewis FW: Cilller w Informatlon about Death High

Morning Sunny,

I am forwarding you this e-mail. This is in response to the e-mail you sent on Tuesday,

October 19, 2010, regarding aNarconon progam.

Hope this helps!

Manuel

From: Sunny Langley Sent: Monday, August 091 2010 3:06 PM To: Manuel Vasquez Cc: Lorraine Espitallier; Laura Venegas; Millicent Gomes Subject: Caller w Information about Death Importance: High

I Just received <1 call from a man who wanted to find out about to locate information on whether a program rating system exists. I explalned what information our website provides. However, during the course of the call he shared with me that he knows of a family who admitted their family member (a· . J) who recently died at Narcanon in Watsonville this year (within

He said that this person had fallen, hit her head, was admitted to the hospital and died at the hospital. Since I have not received a death memo regarding Narcanon in Watsonville, I wondered if this had been reported by the program? Also, the caller said that he would discuss making a complaint to ADP on the program with the family and ·get back to us. I gave him all the proper numbers.

Thank you, Sunny

Corey Sparks From: Marie Montiero Sent: Tuesday, October 19, 2010 3:30 PM To: Corey Sparks Subject: RE: 10-0500: death at Narconon in Watsonville

From: Corey Sparks Sent: Tuesday, October 19, 2010 3:27 PM To: Marie Montiero Cc: Chris Lewis Subject: RE: 10-0SOD: death at Narconon in Watsonville

Hi Marie

I asked you how you found out about the death of the resident and you explained that an attorney for the family had contacted ADP and informed us of the incident. This I heard was from So no info was provided I also asked if you had the information of the person who informed ADP and you said it was in the file. That information is not in the file. I need the contact information of the person who informed ADP of the death of this resident. As I recall, you wanted to know the name of the deceased. That I told you was in the file. NO INFO ON WHO CALLED IN THE INFO

Thanks!

)iHMJ 6P',7ofj 5//f,if:s lnvAstiQfJto,· I Dept o! Alcohol N1cl Drug Propmn,s 1700 I, Street I SC:'contl l'loor I Sacra,nEcn!O CA 05811 Offic:r, 016.445.5085 I Fa~ 916.:122.6912 I Celi 9'16.296.0457

From: Marie Montiero Sent: Tuesday, October 19, 2010 2:30 PM To: Corey Sparks Subject: RE: 10-0500: death at Narconon in Watsonville

No. I told you all I know. Ask me again if you forgot

From: Corey Sparks Sent: Tuesd~y, October 19, 2010 2:21 PM To: Marie Montiero Cc: Chris Lewis Subject: 10·050D: death at Narconon in Watsonville

Hi Marie

I looked through the FOB file and found no documentation of the person who informed ADP of the death of the resident at Narconon. Do you have any further information? _

•' ..

Thanks,

)Atr • .tf 6PFt-f :'5;/:,1ti lnvf-~1.i~8H)r I 0(-;f)t of Alc.oliol ;;:ind Drug F1ro~)rnn1s i 70CJ ~~ Strr~t:;t \ SE-r ,rind Floor ! Sac;ra1ne1110 CA 958 I 1 Uflice fl1f).445 50851 F~,. 81G.322.5H12 I Ce,II ta1G.286 0451.

-· SIATE OF CAui:oRNIA - HEAL TH ANO HUMAN SERVICES AGENCY A~NOLO SCHWARZ.ENEGGSR, GoYe/'fiOr

DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS 1700 K STREET SACRAMENTO, CA 95811-4037 TIYiTDD (800) 735-2929 (916) 322-2911

Dear.

RE: Complaint Number 10-0500

The Department of Alcohol and Drug Programs has received your correspondence regarding Narconon of Northern California, located in Watsonville, California. Your complaint has been assigned complaint number 10-0500. Please refer to this complaint when corresponding with this office.

A review of your complaint has been conducted. We may need to contact you for further information. If you have any questions, or additional information that may be helpful, please contact me at (916) 324-8436 or by e-mail at [email protected].

Thank you for bringing your concerns to our attention.

Sincerely,

-· ·i\J\~ 0\J/~ MANUEL VASQUEZ Complaint Intake Coordinator Program Compliance Branch Licensing and Certification Division

00 YOUR PAR'r TO HEL.P CALIFORNIA SA.VE ENl:RGY For energy saving tips, visit the Flex Your Power website at

http:tlwww fypower.grg

\ \I·"

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 02/08

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY 10 NUMBER: PROGRAM/FACILITY NAME:

440009CN Narconon of Northern California

Department of Alcohol .and Ptug Programs Licensing i;inr;I Certification Division

1700 K Street. Sacrarnerito, CA 95.911 TDD (916) 445·194:2, F.ax (916)J2.2-265B

(916)322-2911

COMPLAINT INVESTIGATION NUMBER;

10-0500

REFERENCES: (1) Health and S.efety Code Section 11634.01 and Californla Code of Regulations (CCR). Title 9, Seclion 10502. Departmenl'al Authority to License. (2) Health and Human Services Agency, Oepartment of Alcohol and Drug Programs, Alcohol and/or Other Drug F'rogram Cer1.iflcatlon Slandards.

PROGRAM/FACILITY LEGAL NAME: Nacronon of Northern California

ADDRESS (Street, City and Zip): 262 Gaffey Road, Watsonville, CA 95076 TYPE OF INVESTIGATION;

DATE OF SITE VISIT: November 7, 2011 and November 8, 2011

TYPE OF PROGRAM/FACILITY; (Please check all that applies)

O COMPLAINT O FOLLOW-UP [8J RESIDENTIAL O NONRESIDENTIAL O OETOXIFICATION O NTP O DUI

O UNLICENSED [8JDEATH [8J AOD LICENSED O OMC CERTIFIED O ADOLESCENT O PERINATAL

O COUNSELOR MISCONDUCT-The Counselor Investigative Report may be referred upon.

i:8J AOD CERTIFIED O COUNTY OPERATED O CDCR AFTER CARE PROGRAM


D NO DEFICIENCY (Licensed and/or Certified Programs)

[8J DEATH INVESTIGATION (Licensed and/or Certified Programs)

[8J CERTIFICATION (AOD Certified Programs)

[8J NOTICE OF DEFICIENCY (Licensed Programs)


O INTERDEPARTMENTAL REFERRAL

The investigation was conducted In accordance wilh California Code of Regulations (CCR), Title 9, Chapter 5, and/or the Alcohol and/or Other Drug

Program Cer1;fication Standards which may include the following: inspection of the program premises, review of program policies1 procedures,

staff and resident flle(s)1 and the interview of residents and staff. In addition, the complaint Investigator s~all notify the llcensed and/or certified

program/facility director or his/her deslgnee of the allegation(s) during the exit conference. (The ADP 90801 Detail Supportive Information form and

ADP 7025, Confldential Names form may be refarred upon.)

( TELEPHONE: 916 445-9153 TELEPHONE: 916 327-5693


PROGRAM/FACILITY REPRESENTATIVE DATE' Please sion above, Initial anv following pages and return the orfofna/ to ADP.

TELEPHONE NUMBER:

/2-DATE


Department of Alcohol and On.1g Programs Licensing and Cenlflcation Division

1700 K Street, Sacramento, CA 95811 TOD (916)445·1942, Fox(916) 322-2658

(916)322·2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: 440009CN . Narconon of Northern California I


10-0500

REFERENCES: (1) Heallh and Safety Code Sec\ion 11834.01 end California Code of R.egulatlons (CCR). Tltle 9, Seellon 10502. Depal'\ml!!:nta! ~ulhorily to License. (2) He:allh and Human Services A~l!:ncy, Department of Alcohol and Drug Prograrns, Aleohol and/or Other Drug Program Cert1f,catlon Standards.

FINDINGS

1!HE FOLLOWING DEFICIENCY(IES) WERflDENTIFIED AND SUBSTANTIATED DURING THE COURSE o.F CLASS THE INVESTIGATION:

. I

1. Licensee did not notify the Department of Alcohol arid Drug Programs of Decedent's A death until one vear after the death of Decedent.

2. Licensee did not send a report of the death of Decedent until one year after Decedent's A death.

3. Licensee did not possess policies and procedures ensuring Decedent sought timely A medical treatment.

4. Licensee provided an inaccurate statement to the Department of Alcohol and Drug B Proarams.

5. Licensee did not ensure Decedent was afforded safe, healthful and comfortable A accommodations to meet Decedent's needs.

6 . Licensee staff did not complete the required Resident Health Screening for Decedent B

7. Licensee did not ensure its counseling staff was licensed, certified, or registered six B months from date of hire.

8. Licensee failed to ensure personnel are tested for Tuberculosis annually. B


Investigative Procedure Complaint Analyst (Hereinafter "CA Alatorre") made an unannounced investigative visit to Narconon of Northern California ("Licensee") at the above address to investigate death investigation number 10-0840 and complaint numbers 10-030, 10-059, 10-152, and 11-030 on November 7, 2011 and November 8, 2011, respectively.

Upon arrival at the Licensee's address, CA Alatorre presented Licensee's Senior Director of Administration, Nathan Tuddenham (Hereinafter "SDA Tuddenham"), with a signed Notice of Inspection of Confidential Records and a signed Notice of Retention of Confidential Records. CA Alatorre requested that the documents be dually signed by the Executive Director or designee and requested copies of the two aforesaid documents. SDA Tuddenham returned an executed copy of the Notice of Inspection of Confidential Records and an executed copy of the Notice of Retention of Confidential Records. CA Alatorre subsequently requested a walk-through of the facility. SDA Tuddenham led CA Alatorre on a walkthrough of the facility. CA Alatorre inspected Licensee's resident rooms, medication room, saunas, recreational facilities, and locations wherein group therapy and one and one therapy are held. Licensee's facility was free of debris and clutter, items were stored neatly, and program participant file cabinets were locked. '·

/z-7 I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HER!c: ____ -l-------

Program/Facilty Repre$entative

PAGE:

2 of 16

-·

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADI=' 60151.,, Revised 01/08


Ocpanment of Alcohol and Drug Programs Licensing i:lnd Certification Olvlsion

1700 K Street, Sacramento, CA 95!!11 TOO (916)'45·1942, Fox (916) 322·265"

{916) :322-2911


10·0500 ~EFERENCES; (1) Health and Safety Code Section 11834.01 arid California Code of Re~ulations (CCR), lille 9, Seclion 10502. Departmental Authorily to Licen:se.

(2) Heallh and Humafi Services Agency, Department of Alcohol and Orug Flrograms, Alcotiol and/or Other Drug F'rogram Cerllficalion Slandal'ds.


CA Alatorre conducted staff and resident interviews for the purpose of this investigation. CA Alatorre also requested and received medical records and documentation probative to the findings of this investigation. The California Department of Alcohol and Drug Programs maintains a copy of all documents referenced as the basis of a deficiency for the purposes of due process of law and other requirements as provided by statute.

Overview Licensee admitted Resident#1 (Hereinafter "Decedent") to Licensee's residential treatment program on __ .. __ .... , _ _ _ 1ecedent's first complaint of illness occurred on _ Decedent requested to be transported to the emergency room where she was admitted. On -

, Decedent expired at the -_ certificate of death was signed by Dr. Steven Smith,

M.D. The cause of death was declared by Dr. Steven Smith, M.D. as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a sum of fourteen days prior to Decedent's expiration. -

Detailed Chronological Manifest of Decedent's Illness On J • - , . a progress note was made my staff member (nursing assistant}, Emma Thomas. Emma Thomas indicated that Decedent had "flu symptoms", "throwing up", "achy (sic.) body'', "hot & cold chills, and sweats". Decedent's temperature was recorded at 101.6.


On • at 10:30AM, Emma Thomas documented in Decedent's residential chart, "Still has flu-symptoms.cold/hot chills, achey (sic.) body, cough". Decedent's temperature was recorded at 103.1. A further notation was made "If fever continues to rise possible ER".

On . _ • at 2:20 p.m. Emma Thomas documented in Decedent's residential chart, "T. 98.6, very sweaty, fever broke" and "continue resting. Will re-check around dinner".

CA Alatorre did not locate a progress not for Decedent for the recheck that was to occur on the evening of

--··..,

On¥-·, -., Jime not specified), Emma Thomas documented in Decedent's residential chart, "was doing good in AM, but is starting to feel worse again." Decedent's temperature was recorded at 99.9. Emma Thomas further records, "Will re~check in the PM".

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: __ n;z_--+------Program/Facillty Representative

PAGE;

3 of 16

·'

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY ADP 601~L, Revised 01108

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER; I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California

Depart.m~nl of Alcotiol and Drug Progr.aJl1$ Licensing and Certlficallon Dlvl~lon

1700 K street, S~cramento, CA 95811 TDD (916) 445·1942, F:Ei>.:: (916) :322·2EiS8

(916) 322-2911

I COMPLAINT INVESTIGATION NUMBER: 10-0SOD

REFERENCES: (1) Health and Safety Code Seclion 11834.01 and California Code of Regulations (CCR), Tille 9, Section 10502. Departmenlal Authority to License. (2) Heelth and Human Services Agency, Department of Alcohol and Drug Program5, Aleohol and/or Olher Dru~ Program Cerlification S1andards.

On . at 11 :40 a.m., Registered Nurse Christina Kuzio, RN/HCO (Registered Nurse/Health Care Officer) documented in Decedent's residential chart, "continues to feel sick, cough, chest discomfort, chills, ~appetite, body aches.", "Brought daily meds", and "Continue to rest- monitor temperature offer Urgent Care". Registered Nurse Christina Kuzio further reported, "Taking liquids not eating," Decedent's temperature was recorded at 103.2.

CA Alatorre did not locate a progress note for Decedent for the recheck that was to occur on the evening of

On _ . ::mma Thomas documented in Decedent's residential chart, "Last night .. ,temperature was at 103.6. Her [Decedent] bed sheets were covered in sweat and I could feel the heat coming off of her body. I insisted that she get into the bathtub full of luke-warm water to try and help bring her temperature down, and it would a/so make her feel better since she had not showered in three days. I had to assist her in doing this (getting into bathtub). I left her in the bath for about 10-15 minutes, while I ran up to the linen closet and got new sheets. I re-made her bed, and then helped her get out of the bath tub. I gave her two tabs of Tylenol ... "" ... / got a dispatch from him [staff member Craig Schiavetta] saying that at 7:30am he checked [Redacted name of Decedent] temp and it was 103.9. I discussed going to ER with [Redacted name of Decedent] yesterday and she declined due to financial issues ... "

On .. ~urse Practitioner Rebecca McKenzie diagnosed Decedent with a lower respiratory infection. Nurse Practitioner Rebecca McKenzie further documented in her • treatment report, "patient was educated to do deep breathing, "go to urgent care or ER if worsening". Decedent was prescribed a Zithromax 250MG regimen to be taken two times on the first day and daily thereafter for a total of four days. Decedent's temperature was recorded at 100.7

On _ , ____ .,etween 1 :40 p.m. and 2:1 O p.m. Christina Kuzio, RN/HCO, documented in Decedent's residential chart, "dry cough persistent" and "Had 181 dose of Zithromicin". Decedent's temperature was recorded at 100.6.

On , Christina Kuzio, RN/HCO documented in Decedent's residential chart, "Last tylenol@ 725AM today was 100,2 by Craig", and that present temperature was "99. 7". Christina Kuzio, RN/HCO further documented, " .. . this is the longest she has gone without spiking high fever.,. "and "This is the most alert/awake I have seen her",

On _ _ .':mma Thomas documented in Decedent's residential chart, " .. . She (Decedent] refused to go to Urgent Care or the ER due to financial issues .. "' She was seen by Rebecca (in her room because she would not walk down to our office)" .. She started antibiotics her fever has subsided and been at a normal temp for the past 2 days. I have been going down to her room since Saturday ' _ " I told her since she has had a normal temp for past two days she would have to starl coming down to my office to get her meds. She said she would no do this because she is in too much pain. She said all of the muscles in her body hurt from coughing. I am not sure what the next course of action should be With her,

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: __ #t;l_-"'1---------~ Pr~ilitv Recresentath,e

PAGE:

4 of 18

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01/0S


Department of Alcohol and Orug Program~ Licensing and Certlfl.catiori DiVi.SIOl'I

1700 K SlreEt, Sa.eramerno, CA. 958-11 TOD (910)445-1942, Fax (916) >22-2658

(916) 322-2911


10"0500 REFERENC!:;.S: (1) Heallh and Safety Code Section 11834.01 and California Code of Regulations (CCR), Title 9, Se:ellon 10502. Departmental A1,11hority to Ucense.

(2) Heallh .1;1nd Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Dn.1~ Program Ceriification Standards.

as all medical options have been exhausted and she is constantly on HLO lines ... "

CA Alatorre again did not locate an progress note for Decedent.

On Emma Thomas documented in Decedent's residential chart, "Today I went down to [Redacted name of Decedent]'s room to check on her and give her daily meds. As soon as I walked into the room told me that she couldn't breathe and that she wants to go to the hospital. I told her that I would have to arrange transport, and I personally wouldn't be able to take her until the afternoon because Rebecca NP was coming to see New Starls. [Redacted name of Decedent] told me she wanted to go ASAP. I told her I would talk to Ashly RSS and figure it out ... / went down to Ashly's office and told her what [Redacted name of Decedent] told me."

On - , .:mma Thomas documented in Decedent's residential chart, "last night I went to visit [Redacted name of Decedent] at the hospital to check on how she was doing. She was hooked up to two different /Vs, and looked very ill ... She told me that she had been really lonely since she has been in her room at the center alone for a week, and now she was alone in the hospital room .... / looked at the bags [Redacted name of Dec;edent] was hooked up to, I didn't recognize the name of one (it was most likely an antibiotic) but the other one- was potassium. [Redacted name of Decedent] told me that the doctors said her potassium levels were dangerously low, and so were her blood oxygen cells, so they had her hooked up to an oxygen taken too ... [Redacted name of Decedent] did not natter or speak badly about Narconon for making her go on an LOA, and she did not say anything about us not taking action sooner to prevent her from getting pneumonia ... "

On

On _ . _ a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration.

On a Narconon of Northern California discharge summary was signed by an unknown Narconon of Northern California Employee.

Staff Interviews concerning Decedent's Illness On . ::,A Alatorre presented proper identification to SDA Tuddenham and informed SDA Tuddenham of the overall nature and purpose of CA Alatorre's visit.

CA Alatorre asked SDA Tuddenham about the practices and polices of the Narconon of Northern California Residential Program. SDA Tuddenham informed CA Alatorre that residents track their progress by the completion of books. There are a total of eight (8) books within the program. At book two (2), this is

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: ~7--ci,rnnrarn1i=~,..11;h·t r'i61'11'Clf:6t'lt~tlu6

PAGE:

5 of 18

STATE OF CALJFORNIA-HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, R.eVIEied 01/08

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: 440009CN - Narconon of Northern California

CeparlmEnt of Alcohol and Drug F'rogram:!i Lleerislng and Certificalloh Division

1700 I( Street, $:;icramenlo, CA 95811 TDD (916) 445·1942, Fax (916) 322-265,S

(916) 322-2911

I COMPLAINT INVESTIGATION NUMSER:

10-05DD REFERENCES: (1) Health and Safely Code Section 11 a~4.01 and Callfornla Code of Re9u1alrons (CCR.). Tltle 9, Sec:lion 10502. Departmental Aulhorlly to License.

(2) Health and Human Services Agency, Department or Alcohol and Drug Pro~rams, Alcohol and/or Other Drug Prograrn Certification Standards.

when the students (residents) are integrated into the sauna portion of the program. A student cannot continue to the next book until they have completed book two unless medical conditions dictate they are ineligible to participate in that portion of the program. SDA Tuddenham confirmed Decedent was past book two of the program. Decedent's program and medical records confirmed Decedent was past book two and already successfully completed the sauna portion of the program ..


At approximately 1100 hours, CA Alatorre proceeded to ask Registered Nurse Christina Kuzio her recollection of the condition of the Decedent at Licensee's facility prior to the Decedent being transported to the local emergency hospital. At which time, Registered Nurse Christina Kuzio stated "I've been around long enough to.know when I need to have representation and what I need to do to protect my license. I will not speak to you without representation present." At which time, CA Alatorre concluded the interview and continued to tour the facility. CA Alatorre advised SDA Tuddenham that CA Alatorre would not object to allowing Registered Nurse Christina Kuzio's legal representation be present during an interview, but CA Alatorre did need to ascertain what Registered Nurse Christina Kuzio's observations of the Decedent were in order to complete CA Alatorre's investigation.

At approximately 1600 hours, SDA Tuddenham informed CA Alatorre that Registered Nurse Christina Kuzio was willing to speak with her without legal counsel present. Registered Nurse Christina Kuzio stated that she did not initially understand the purpose of CA Alatorre's visit and where CA Alatorre was from. CA Alatorre advised Registered Nurse Christina Kuzio that CA Alatorre did not object to her having counsel present and her waiver of such was of Registered Nurse Christina Kuzio's own informed consent. Registered Nurse Christina Kuzio thereafter acknowledged CA Alatorre's statement and cooperated with CA's investigation and interview. CA Alatorre asked Registered Nurse Christina Kuzio what her recollection of Decedent was. Registered Nurse Christina Kuzio confirmed that she did recall Decedent and recalled that multiple advisements were provided to the Decedent that she should go to a hospital if she did not feel well. Registered Nurse Christina Kuzio relayed Decedent fervently refused as Decedent did not have health insurance which made it economically onerous for Decedent to seek treatment. Registered Nurse Christina Kuzio stated that the Decedent was closely monitored and was seen by a nurse practitioner that works with the program. Registered Nurse Christina Kuzio stated that the nurse practitioner had prescribed the Decedent prescription antibiotics and told the Decedent that if her condition worsened to go the emergency room. Registered Nurse Christina Kuzio further stated the death of the Decedent was "the only time something like this has happened". Registered Nurse Christina Kuzio and SDA Tuddenham both acknowledged there was not a written policy concerning potential imminent illness and injury at the 'time of Decedent's expiration. CA Alatorre asked Registered Nurse Christjna Kuzio if the Decedent was in the Sauna portion of her program. Registered Nurse Christina Kuzio confirmed the

I HAVE READ AND UNDERSTAND THE AEIOVE INFORMATION. PLEASE INITIAL HERE; __ /Al_,__ _____ _ Pro;;;;t;;;cllitv ReD~sl:!nti:!tlvl:!

PAGE:

6 of f8

STATE OF CALIFORNIA-HEALTH ANO HUMAN SERVICES AGENCY AOP 6015L1 Revised 01/08

Departmenl of Alcohol .and Orug 1=1'rograms. Lic:cn~ing .and Certific.'.l.llon Dlll'i$IQn

1700 K StreC;t, S:iicramenlo, CA 958:11 TOO (916) 445·1942, Fox (916) 322-2650

(916) >22-2"11


COMPLAINT INVESTIGATION NUM0ER:

10-0500 REFE.RENCCS: (1) He:;ilth and Safety Code Sec!lon 11SJ4.01 and Califol'nla Code of Regulations (CCR), Tiile 9, Seetion 10502. Departrnenlal Aulhority lo Licen~e.

(2) Healih and Human Services Agency, Department of Alcohol and Drug F'rograms, Alcohol and/or Other Drug Program Certifii::.ation Standards. ·

Decedent was not in the Sauna portion and that the decedent was many books (steps) past that phase of the program. Registered Nurse Christina Kuzio confirmed that the nursing assistant, Emma Thomas, is no longer employed at Narconon of Northern California.

1.


REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10561, Reporting Requirements provides, in part:

" ... (b) Upon the occurrence of any of the events identified in Section 10561 (b) (1) of this subchapter the licensee shall make a telephonic report to department licensing staff within one (1) working day. The telephonic report is to be fol/owed by a written report in accordance with Section 10561 (b} (2) of this subchapter to the department within seven (7) days of the event. If a report to local authorities exists which meets the requirements cited, a r::opy of such a report will suffice for the written report required by the department ... "


SUMMARY: Licensee admitted Decedent to Licensee's residential treatment program on Decedent's first complaint of illness occurred on . _ . Decedent requested and was transported to the emergency room where she was admitted. On _

, Decedent expired at the hospital intensive care unit. On _ a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration.

On _ · Marie Montiero, Field Operations Branch Analyst with the Department of Alcohol and Drug Programs (ADP), contacted Jeff Panelli, Senior Director of Administration at Narconon of Northern California (Hereinafter "SDA Panelli"), to inquire about Decedent's death.

SDA Panelli told Ms. Montiero that there was a death at the facility; however it was over a year ago. SDA Panelli further stated that because the death did not happen at the facility, it was not reoorted to ADP.

II , HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: __ #._--='-"+?-... -. -_----- I PAGE:

?offs

STATE OF CALIFORNIA-IJEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01108

Dep~nmenl of Ale.oho! ~nd Drug Programs Licl:lnSiJl9 and Certification Olvlsion

1700 K Slreet, Saerarnerito, CA 95811 TOO (916) 4'5-1942, Fax (916) ,22.26SB

(916) 022·2911



REFERENCES; (1) Health and Safely Code Section 11a:;4_01 and Calirornia Code of Re~1..11atlons (CCR), Title 9, Seellon 10502. Deoanmental Authority to License. (2) Health and Human Services Agency, OeparLmenL of Alcohol and Drug F'rograms, Alcohol :;ind/or Other Drug Program Certific:;i1ion Standards.

Based on the findings, the Licensee failed to make a telephonic report to ADP staff within one (1) working day of Decedent's death. Thus Licensee is noncom pliant with California Code of Reoulations ICCR\, Title 9, Division 4, Chaoter 5, Subchaoter 3, Article 2, &10561. DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's death until one year after the death of Decedent.

REGULATORY AND/OR CERTIFICATION STANDARD REOUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10561, Reporting Requirements provides, in part:

" ... (b) Upon the oocurrence of any of the events identified in Section 10561 (b) (1) of this subchapter the licensee shall make a telephonic reporl to. department licensing staff within one (1) working day. The telephonic report is to be followed by a written report in accordance with Section 10561 (b) (2) of th.is subchapter to the department within seven (7) days of the event. If a report to local authorities exists which meets the requirements cited, a copy of such a report will suffice for the written report required by the department ... "


SUMMARY Licensee admitted Decedent to Licensee's residential treatment program on

2. Decedent's first complaint of illness occurred on . __ --, Decedent I requested and was transported to the emergency room where she was admitted. On . . lecedent expired at the hospital intensive care unit. On _ a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration.

On . , ,v1arie Montiero, Field Operations Branch Analyst (Hereinafter "FOB Analyst Montero") with the Department of Alcohol and Drug Programs, contacted Jeff Panelli, Senior Director of Administration at Narconon of Northern California (Hereinafter "SDA Panelli"), to inquire about Decedent's death.

SDA Panelli told FOB Analyst Montiero that there was a death at the facility; however it was over a year ago. SDA Panelli further stated that because the death did not happen at the facility, it was not reoorted to ADP.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE: INITIAL HERE:_~~--,....-._-..• -. -----. -.• --PAGE: B of 18

STATE OF CALIFORNIA-HEALTl'I AND HUMAN SERVICES AGENCY ADP 6015L, Revised 011013

Dep:artment of Alcohol and brus Programs Licensing and C~rtlfleatlon Division

1700 K Streel, S""crame11to, CA 95811 TDD (916)...,5-19'2, Fax (916) '22·265"

(916) 322·2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-050D REFERl:=NCES; (1) J,-leallh and Sarety Code Secllon 11834.01 and Califotnia Code of Regulations (CCR.), Title 9, Section 10502. Departmental Aulhorily lo License.

(2) Health and Human Services Agency, Dep,;irlrnent of Alcohol and Drug Programs, Ah;ohol and/or Olher Dru~ F1rogram Certlficallon Standards.

On or about RAS.

_icensee sent the death incident report signed by Scott Friend,

Based on the findings, the Licensee failed to send a written report in accordance with Section 10561 (b) (2) of this subchapter to the department within seven (7) days of Decedent's death. Thus Licensee is noncompliant with California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10561.

DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did not possess policies and procedures ensuring Decedent sought timely medical treatment

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): The Alcohol and/or Other Drug Program Certification Standards, Health Questionnaire, § 12055 provides:

"If during the course of recovery or treatment services, the participant is assessed and determined to be in need of additional services, the program shall provide the participant with a referral to the appropriate services, if available. The program shall maintain and make available to participants a current list of resources within the community that offer services that are not provided within the program. At a minimum, the list of resources shall include medical, dental, mental health, public health, social services and where to apply for the determination of eligibility for State, federal, or county entitlement programs. Program policies and procedures shall identify the conditions under which referrals are made. For each participant for whom a referral is made, an entry shall be made in the participant's file, documenting the procedure for making and following-up the referral, and the agency to which the referral was made."

The Alcohol and/or Other Drug Program Certification Standards, Referral For Medical or Psychiatric Evaluation and Emergency Services,§ 12050 provides: "The program shall have written procedures for obtaining medical or psychiatric evaluation and emergency services. All program staff having direct contact with participants shall, within the first year of

3. employment, be trained in infectious disease recognition, crisis intervention referrals and to recognize physical and psychiatric symptoms that require appropriate referrals to other agencies."

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10563 provides: ''The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation."

SUMMARY:

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: ~fi'l--+--------..... _ -···- ·-- .... __ , .... PAGE:

s of 18

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY AO!=' 601SL, Revised 01108

Oepartment of Alcohol and Dr1,19 Programs Licensing and Certificallon Olvlsion

1700 K Street, S0cramen1.o, CA 95811 TOO (916) 445·1942, Fox (916)322-2658

(916) 322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY 10 NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-0500 REFERENCES; (1) Health and Safety Code Section 118~4.01 and Callfornla Code of Regulations (CCR), Til!e !;!, Section 10502. Deparlrner1lal Aulhorily to License.

(2) H1:ialth and Human Services Agency, Deparlmem of Alcohol and Dn.lg Programs, Alcohol end/or Other Drug Program Certificstion Standards.

4.

Registered Nurse Christina Kuzio confirmed that she did recall Decedent and recalled that multiple advisements were provided to the Decedent that she should go to a hospital if she did not feel well. Registered Nurse Christina Kuzio relayed Decedent fervently refused as she did not have health insurance which made it economically onerous for her to seek treatment. Registered Nurse Christina Kuzio stated that the Decedent was closely monitored and was seen by a nurse practitioner that works with the program. Registered Nurse Christina Kuzio stated that the nurse practitioner had prescribed the Decedent prescription antibiotics and told the Decedent that if her condition worsened to go the emergency room. Registered Nurse Christina Kuzio further stated that the death of the Decedent was the only time something like this has happened. Registered Nurse Christina Kuzio and SDA Tuddenham both acknowledged there was not a written policy concerning potential imminent illness and injury at the time of Decedent's expiration. CA Alatorre asked Registered Nurse Christina Kuzio if the Decedent was in the Sauna portion of her program. Registered Nurse Christina Kuzio confirmed the Decedent was not in the Sauna portion and that the decedent was many books (steps) past that phase of the program. Registered Nurse Christina Kuzio confirmed that the nursing assistant, Emma Thomas, is no longer employed at Narconon of Northern California.

Based upon the interviews of Registered Nurse Christina Kuzio and SDA Tudddenham, licensee did not maintain a resident medication log for the Decedent. The Licensee is noncompliant with Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10563, Alcohol and/or Other Drug Program Certification Standards §12050, and Alcohol and/or Other Drug Program Certification Standards §12053.

DESCRIPTION OF THE DEFICIENCY: "CLASS B" Licensee provided an inaccurate statement to the Department of Alcohol and Drug Programs.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10510, Prohibition against False Claims Regarding Licensure, provides: "No licensee, officer, or employee of a licensee shall make or disseminate any false or misleading statement regarding licensure of the facility or any of the services provided by the facility."

On I . Marie Montiero, Field Operations Branch Analyst (Hereinafter "FOB Analyst Montero") with the Department of Alcohol and Drug Programs, contacted Jeff Panelli, Senior Director of Administration at Narconon of Northern California (Hereinafter "SDA Panelli"), to inquire about Decedent's death.

SDA Panelli told FOB Analyst Montiero that there was a death at the facility; however it was over a year ago. SDA Panelli further stated that because the death did not happen at the facility, it was not reported to ADP.

II I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _4l:..:_~,f-7 _______ 1 PAGE:

10of1B

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 60151.., Revised 01/08

Deparlml:lnt of Alcohol and Drus 1=1rogram5: l.iccn~tng ;;ind Certification Division

1700 K Streel, Sacramel"lto, CA 95811 TOO (916) 445-1942, Fa>< (916) 322-26SB

(916) 322·2911



10-0500 REFERENCES; (1) Health and Safety Code Section 11834.01 and California Code of R.@gulatlons (CCR), Title 9, Section 10502. Dep~rlrnenta1 Authority lo License.

(2) Health and Human Services Agency, Departmenl of Alcohol and Drug Programs, Alcohol and/or Other Drug Progriam Certlfie;ation Standards.

5

On or about. , __ .. , Licensee sent the death incident report signed by Scott Friend, RAS. The report was dually executed by Program Director Daniel Manson CCDC, RAS.

Scott Friend, RAS, represented to the department on the unusual incident/injury/death report form, ' Was given options to be transported to ER or D/C'd on medical leave. -·. . Seen by ER staff and admitted for pneumonia"

CA reviewed the :eport of staff member Emma Thomas concerning Decedent's condition which stated, "Today I went down to [Redacted name of Decedent] to check on her and give her daily meds. As soon as I walked into the room told me that she couldn't breathe and that she wants to go to the hospital. I told her that I would have to arrange transport, and I personally wouldn't be able to take her until the afternoon because Rebecca NP was coming to see New Starts. [Redacted name of Decedent] told me she wanted to go ASAP. I told her I would talk to Ashly RSS and figure it out .... I went down to Ashly's office and told her what [Redacted name of Decedent) told me."

Accordingly, it does not appear from the record that Decedent was provided an ultimatum of go to the emergency room or you will be discharged. It appears Decedent, from her own volition and without any advisement, requested to be transported to the emergency room immediately.

Based on the review of Licensee's Jnusual Incident/Injury/Death Report form and the ·eport of staff member Emma Thomas concerning Decedent's condition Licensee is noncompliant of California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10510.

DESCRIPTION OF THE DEFICIENCY: "CLASS A" Licensee did not ensure Decedent-was afforded safe, healthful and comfortable accommodations to meet Decedent's needs.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10569, Personal Rights provides: "(a) Each resident shall have personal rights which include, but are not limited to, the following: ... (3) To be accorded safe, healthful and comfortable accommodations to meet his or her needs ... "

SUMMARY: CA Alatorre reviewed the Decedent's chart and all materials gathered during the course of the investigation. CA Alatorre reviewed the , . ____ ;hart note of Emma Thomas.

On · · · - - - --:mma Thomas documented in Decedent's residential chart, "Last ....._ __ -.,__;:...;.c. __ _

I HAVE READ ANO UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:-----'---A.:;0__,,...._ _____ _ Pl'=±51r.ilitv RPnrP .. Pnt~ti'Vt>

PAGE:

11of1B

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revis.Cd 01/08


Department of Alcohol .and Drug F'rogr~ms Licensing and Certification Division

1700 K Street, .Sacramento, CA 9SS11 TDD (916) 445·194:2, Fax (916) 322-2658

(916) 322-2911


REFE:.R.ENCES: (1) Health and Safety Code Section 11,6S4.01 and California Code of Regulations (CCR.), Title 9, Section 10502. Department:;il Authority to l..icense. (2) Health and Hurn:;in Services Agency, Depariment of Alcohol and Drug Progr.1;1rns, Alcohol and/or Other Drug Program Certification St"a.nd:;irds.

night ... temperature was at 103. 6. Her [Decedent] bed sheets were covered in sweat and I could feel the heat coming off of her body. I insisted that she get into the bathtub full of lukewarm water to try and help bring her temperature down, and it would also make her feel better since she had not showered in three days. I had to assist her in doing this (getting into bathtub). I left her in the bath for about 10-15 minutes, while I ran up to the linen closet and got new sheets. I re-made her bed, and then helped her get out of the bath tub. I gave her two tabs of Tylenol ... "" ... I got a dispatch from him [staff member Craig Schiavetta] saying that at 7:30am he checked Ilene's temp and it was 103.9. I discussed going to ER with [Redacted name of Decedent] yesterday and she declined due to financial issues ... "

On _ Decedent requested and was transported to the emergency room where she was admitted. On . Decedent expired at the hospital intensive care unit. On , a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as respiratory failure which occurred four days prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered viral pneumonia for a total of fourteen days prior to decedent's expiration.

Decedent had the right to be accorded safe, healthful, and comfortable accommodations to meet her needs. The . _ chart note prepared by Emma Thomas reflects Decedent was so weak; she could not even make it to the bathroom tub unassisted. Further chart notes by Emma Thomas and Registered Nurse Christina Kuzio reflect that Decedent was so weak that from . to her admittance in the hospital emergency room on August 4, 2009, she could not even retrieve her fever and pain reducing medications at the nurse's station on site at Licensee's facility.

Based on: 1. Review of Decedent's Chart 2. Interview of SDA Tuddenham; 3. Interview of Registered Nurse Christina Kuzio; and, 4. Decedent's death certificate;

Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10569 (a) (3).

DESCRIPTION OF THE DEFICIENCY: "CLASS B" Licensee staff did not complete the required Resident Health Screening for Decedent.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10567(a) provides: "(a) Every resident shall complete a health questionnaire which shall identify any health problems or conditions which require medical attention, or which are of such a serious nature

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEAS!': INITIAL HERE: _4L-_c....-=,,7-~·-----Cl'r .... nr~,ii:::!.1,..Jllhl. Die.l'lr't!>e~l"llt:llltlvo111

PAGE:

12 of 18

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY AOP 6015L1 ~evised 01/08

Department of Alcohol and Drug Progr~ms Lleenslng and Certification Division

1700 K Street, Sacr:amento, CA 9SG11 TOD (91Ei) 445-1942, Fa); (916) 322-2658

(916)322-2911



REFERENCES; (1) Health and Safety Code Section 11634.01 .and Callfornla Code·of Regulalions (CCR), Title 9, Seci.ion 10502. Depanmenlal Authority to l.icense. (2) Health and Human Services Agency, Department of Alcohol and D{UQ F'rograms, Alcohol :;ind/or Other Drug Program Certification St1;1nd:;irds.

as to preclude the person from participating in the program."

5. Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10567(c)(1 ) provides: " .. . (c) Licensee's staff shall carefully review each resident's health questionnaire, interview each resident regarding information given, and ensure that:(1) A resident seeks and obtains medical or dental assistance for any significant health problems while remaining in residency; or (2) Be referred to an appropriate facility which can provide required service."

The Alcohol andfor Other Drug Program Certification Standards, Health Questionnaire, 12020, provides:

"The health questionnaire, shall be completed for all participants admitted for residential or nonresidential alcohol and/or other drug services. Programs may use form ADP 10100-A-E for the health questionnaire or may develop their own health questionnaire provided it contains, at a minimum, the information requested in ADP 10100-A-E. The health questionnaire is a participant's self-assessment of his/her current health status. The health questionnaire shall be completed and signed prior to the participant's admission to the program and filed in the participant's fife.

Program staff shall review each completed health questionnaire. When appropriate, the participant shall be referred to licensed medical professionals for physical and laboratory examinations. A medical clearance or release shall be obtained prior to admission whenever a participant is referred to licensed medical professionals for physical and laboratory examinations. The referral and clearance shall be documented in the participant's file."

The Alcohol andfor Other Drug Program Certification Standards, Participants Files 17015(b)(2)(E) provides, " ... b. At a minimum, each participant file shall contain the following .. . 2. Admission and Intake Data; ... All data gathered during admission and intake including: ... E. Health questionnaire;"

SUMMARY: CA Alatorre reviewed the Decedent's chart and all materials gathered during the course of the investigation. Licensee admitted Decedent to Licensee's residential treatment program on

CA Alatorre did not locate a health questionnaire for Decedent's admittance date on ' On r CA Alatorre requested the health questionnaire from SDA Tuddenham, SDA Tuddenham responded that Licensee did not possess another health questionnaire because Decedent was not ever discharged, but merely transferred to the Licensee's sister facility. SDA Tuddenham stated that a health questionnaire however was completed at the South Lake Tahoe facility (Licensee's sister facility).

Based on:

I HAVE READ AND UNDERSTAND THE A60VE INFORMATION. PLEASE INITIAL HERE: _.:.Af.::....:'=F------Prnnr~m/F:.i.~llltv RAnrAJ:Ant-:dlvA

PAGE:

13 of 18

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY ADP 601.SL, Revised 01/0G

Oepartl'T'lent of Aleohot i!lnd Drug F'ro9r~ms Licensing i;ind Cer11flcation Division

1700 K Stre1::t, Sacrarnonto, CA 95811 TDD (916) 445-1942, '°' (916) S.2·2656

(916) 322-2911


COMPLAINT INVESTIGATION NUMBER: 10-0500 .

REFERENCE.$: (1) He,1:1lth .;111d Safety Code Seetion 118~4.01 ,1:1nd California Code of Ri!:gulations (CCR), l'itle 9, Section 10502. Departmental Aulhorityto License. (2) Heallh and Human Services Agen~y. Oepartmenl of Alcohol and Drug F'rograms, Alcohol and/or Other Drug Program Certific.alion,Stand:ards.

6.

1. Review of Decedent's Chart; 2. Review of Decedent's'·- -· __ .. . "admission agreement"; 3. Interview of SDA Tuddenham;

Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §§10567 (a) and 10567 (c) (1), (3), The Alcohol and/or Other Drug Program Certification Standards §§ 12020 and 17015 (b )(Z)(E).

DESCRIPTION OF THE DEFICIENCY: "CLASS B" Licensee did not ensure its counseling staff was licensed, certified, or registered six months from date of hire.

REGULATORY AND/OR CERTIFICATION STANDARD REQUIREMENT(S): Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §13010 (a), REQUIREMENT FOR CERTIFICATION, provides: "(a) By April 1, 2010, at least thirty percent {30%) of staff providing counseling services in all AOD programs shall be'/icensed or cerlified pursuant to the requirements of this Chapter. All other counseling staff shall be registered pursuant to Section 13035(f)."

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §13005 (4) (A)(B)(C)(D)(F) Definitions provides:

"'Counseling services' means any of the following activities: (A) Evaluating participants', patients', or residents' AGO treatment or recovery needs, including screening prior to admission, intake, and assessment of need for services at the time of admission; (8) Developing and updating of a treatment or recovery plan; (C) Implementing the treatment or recovery plan; (D) Continuing assessment and treatment planning; (F) Documenting counseling activities, assessment, treatment and recovery planning, clinical reports related to treatment provided, progress notes, discharge summaries, and all other client related data."

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10563, provides: "The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation. "


Upon review of Licensee's files, CA Alatorre observed staff member Dylan Chatterton's oersonnel file. Dvlan Chatterton sianed the Narconon of Northern California Job Descriotion

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:---',4,;_;"""--=F7 ______ _ --- ___ i.:_ _ .... -

PAGE:

14 of 18

STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY ADP ij015L, Revised 011oa


Oe~artment of Alcohol and Orug l='rograms L1eenslng and Certiflco!l.tic;,n Division

1700 K Slreet, S.acramento, CA 95811 TDO (916) 445-1942, Fox (916) 322·26,S

(916) 322-2911

PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-0500 REFERENCES: (1) Health and Safely Code Section 11634.01 and California Code of RegulatiOfl!;I (CCR), TILie 9, Seolion 10502. 01:!partmenlal Authority lo License.

(2) Health and Human Servle;es Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program Certification Slandards.

for "Course Supeivisor" on December 8, 2010. In the job description, it specified that Dylan Chatterton's position " ... oversees and helps each student on the section of the program that are done in the Course Room. The Course Supervisor is there to see that the student fully gets and can apply what he/she has studied." CA Alatorre also reviewed another job description signed by Dylan Chadderton on March 20, 2011. In the job description, it again specified that Dylon Chatterton's position is, "Responsible for supervision of NN Program Course Room and running it standardly. This includes helping each student working in the course room successfully complete the course that they are on. He/she is ultimately responsible for the student's knowledge and application of what they have studied." The program required that the supeivisor "Must be registered as a Registered Addiction Specialist Intern (RASi) within 6 months of initial hiring" and "Must attain certification as a RAS within 5 years of registered as a RASi".

CA Alatorre asked SDA Tuddenham where Dylan Chadderton's RAS certification or registration was. SDA Tuddenham confirmed Dylan Chadderton was not licensed, certified, or registered to perform alcohol or other drug treatment counseling services.

Based on the following evidence: 1. Review of Dylan Chadderton's Personnel File; 2. Interview of SDA Tuddenham;

Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §§ 1301 O(a) and 13563.

DESCRIPTION OF DEFICIENCY: "CLASS B" Licensee failed to ensure personnel are tested for Tuberculosis annually.

REGULATORY REQUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, § 10564 (c) (1), Personnel Requirements, provides

"All personnel shall be in good health ... good physical health shall be verified by a health screening, including a test for tuberculosis, performed under iicensed medical supervision not

7. more than 60 days prior to or 7 days after employment with tuberculosis testing renewable every year .... "

California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Article § 10565 (b) Personnel Records provides " ... All personnel shall have on file the record of the health screening as specified in section (c)(1), (2) of this subchapter ... "

I HAVE READ AND UNDERSTAND THE ASOVE INFORMATION. PLEASE INITIAL HERE: _0

•_,4i _ _.-._-,-r-,?-.-.,,.-__ h ___ - __ -_-__ -_.-_ •. --1 PAGE:

15of1S

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01/0G


Department of A.lcohol 21nd Crug l'rograms · Licensing and Certlfleatlon Division

1700 K Street, S:aer~mento, CA 95l:111 rec (916) 445-1942, Fax (!l1S) 322·2.EiSS

(916) 322-2911

PROGRAM/FACILITY JD NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-0500 REFERl::NCES: (1) Health and Sa1e1y Code Section 11 a34.01 and Callfornia Code of Regulations (CCR.), litre 9, Section 1050.2. Departmental Authority to License.

(.2) Heallh and Human Service:;: Agency, Dep1;1rlment of Alcohol and Drug Programs, Alcohol andfor Other Drug Program Certification Standards.


Upon review of Licensee's files, CA Alatorre observed staff member Alyssa Gosselin's personnel file. Alyssa Gosselin's personnel file reflects that Alyssa Gosselin's first tuberculosis test was conducted on !009. Alyssa Gosselins next tuberculosis screening was conducted one year and one month later (13 months later) on __ . -, 2010.

Based on review of employee Alyssa Gosselii,'s personnel file, Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10564(c) (1 ).

NOTICE OF DEFICIENCY - It is important that 1he licensee complies with regulations and the instructions ofthis Notice of Deficiency. Failure of the lic!"lnsee to comply may result in other possible -enforcement actions, such as <license swspension or .revocation. ·

NOTICE OF DEFICIENCY {FOR VIOLATION OF CCR, TJTL:E 9, -Ctt,PT-ER 5 SECTION 10500 et seq. - The licensee shall submit written verification ·of correction for the Class A deficiency{les} idi:mflfied iA this notice of deficiency to ADP within 10 <lays ,of re.ceipt of the nolice cif:deficiency. The written verification shall substantiate that the deficleocyQes) have been ci:irre:Cted :and specify the <iatl:! when the deficiency(les) were corrected. If the licensee cannot correct the :deficiency{Jes) within 10 days -of receipt of this notice, the licensee shall submlt a written Couectlve ACtjon f\lari_ {CAf'} to: Manager, Program Compliance Branch, Department of Alcohol and Owg Programs, H~nslng and 'eertification -Division, 1700 K Street, Sacramento, CA 95811~4037. The CAP ,shall 1nc1ude wb;;it steps the licensee has taken to correct the deficiency(ies ); substantiate why the deficiancy(jes) ieannt>t be corrected as specified in this notice; and specify when the aeficlehcy will be coi'rectl'3a. The written ver4fit:atlon .of correction or written CAP shall be postmarked no Jater than tl:ie date(s) spec:mei:t lo.this notice. The licensee shall submit written ver1fication of correction foi the Class.a and C.:i;leficiericy{i~s) lder.itlftetl 'in this notice of deficiency to ADP within 30 days of:ret¢Jpt of-tlle'ttc;>lite of de:i'iclency. Jf thi:i)icensee -cannot correct the deficiency(ies) Within 30 days of -receipt df fuls notice; t~ l_icensee shaU submit a -Wfitten Coy.active Action Plan (CAP) to: ·Mar;iager, Ptogra.m t:ompli~riiceEinihch;{Jeparl:ment.otA!cobol and Drug Programs, licensing and Certification :[)ivision, 1700 K StrEi,at; S:a:cra111ento; 'CA '951311-4037, The CAP shall include what steps the licensee has taken to .cot;rect ·the i:leficiel;icY(ies); ,substantiate why the deficiency(ies} cannot be corrected ai, specified ill this imiirie;and spe:cifywhell the :defitien:cywllf ·" be corrected. The written verification of correction or written C~P shall be ·postmarted no later .than the date(s) specified in this notice.

Penalt : Failure to correct the above cited deficienc · ies shall result in the assessment of a civil

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: __ ~,h--i_; _ __..,.7~---- PAGE:

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 0110B


bepartment of Alcohol .eind brug Programs Licensing and Certiflcatloh Division

1700 K S1..reel, Saer:11m~nto, CA 9SS 11 TDD (916) 445·1942, Fa, (916) 322-2658

(916)J22·2911


REFERENCES; (1) Health and Safely Code Section 11834.01 and California Code of Regulations (CCR), Tille 9, Section 10502. Departmental Authority to License. (2) Health end Human Services Agellcy, Depi:lrtrnent of Alcohol and Drug Programs. Alcohol and/or Other Drug Program Cer1.iflcalion Standar'ds.

penalty of $50 per day for each Class A deficiency, beginning on the 11'" day after ,receiving thls notice and will continue to accrue until the date the licensee submits verification that the deficiency(Jes) are corrected or until the date a written CAP is received and approved. The dale of submission by the licensee of the written verification of correction, or the written 'CAP, shall be the date that it is postmarked. The maximum daily civil penalty for the deftciency(ies) shall not exceed one hundred· and fifty dollars ($150) per day. Failure to correct the above cited deficlency(ies} shall result in the assessment of a civll penalty of $50 per day for each· Class B deficiency(ies)and $25 per day for each Glass G deficiency(ies), beginning on the 31 •1 day after receiving this notice and will continue to accrue until the date the licensee submits verification that the deficiency(ies) are corrected or until the date a written CAP is received and approved. The date of submission by the licensee of the written verification of rorrection, or the written CAP, shall be the date that it is postmarked. The maximum daily civil penalty for the deficiency(ies) shall not exceed one hundred and fiftv dollars {$150) per dav. ·


IT JS IMPORTANT THAT THE PROGRAMIFACILITY COMPLY WITH THE CALIFORNIA CODE OF REGULATIONS (CCR), TITLE 9.

* * •

NOTICE OF DEFICIENCY - Title 9, Chapter 5, Sections 10543 & 10544, of the California Code of Regulations (CCR), requires the Department complaint investigator/reviewer to prepare a written NOD at the completion of each complaint investigation/licensing compliance review listing all deficiencies noted. The NOD is made a part of the licensing records for the facility and the licensing agency, and is available for public review. Care is taken not to disclose any confidential information in the report. Inquiries concerning the location, maintenance, and content of these reports may be directed to the Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814-4037.

DEFICIENCIES - A deficiency is a failure to comply with any provision of the.regulations pursuant to Chapter 7.5 of Part 2 of Division 10.5 of the Health and Safety Code. The NOD shall specify: the section number, title, and code of each statute or regulation which has been violated; the manner in which the licensee has failed to comply with a specified statute or regulation, and the particular place or area of the facility in which it occurred; the date by which each deficiency shall be corrected; amount of the civil penalty to be assessed in accordance with Title 9, Chapter 5, Sections 10547, CCR, and the date the Department shall begin to assess the penalty, if the licensee fails to correct the noticed deficiencies or submit a CAP.

WRITTEN NOTIFICATION TO DEPARTMENT-The licensee shall submit to the Department written verification of correction for each deficiency identified in this notice of deficiency (NOD). The written verification shall substantiate that the deficiency has been corrected and specify the date when the

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: _ _cfte _ ___,,;z'------- PAGE:

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··--··--

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY 0Bpar1ment of Aleohol and Orug Programs ADP Ei015L, Revi.:sed 01/0B Lleen:sinQ .1;1ncl Certification Division


1700 K Street, Sacramenlo, CA 95811 TDD (916) 445-1942, Fax (916) 322-26SS

(916)322-2911

PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-0500 REFERENCES: (1) Health and Safety Code Seel/on 11 S34.01 and Callfornia Code o1' Regulations (CCR). Tille 9, Section 10502.· Departmental ALI\horlty to Licen~e.

(.2) He1;1llh and Human Services Agency, Depattrnent of Alcohol and Drug Programs, Aleohol and/or Other Drug Program Certification Standards.

deficiency was corrected. If the licensee cannot correct a deficiency within the days specified in this NOD, the licensee shall submit a written CAP to: Manager, Programs Compliance Branch, Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814. The CAP shall include what steps the licensee has taken to correct the deficiency (ies); substantiate why

the deficiency cannot be corrected as specified in this NOD; and indicate the specific date when the deficiency (ies) will be corrected. The written verification of correction or written CAP shall be postmarked no later than the date specified in this NOD.



ALL OTHER DEFICIENCIES - The licensee shall submit to the Department written verification of correction for each deficiency identified in this NOD within thirty (30) days of receiving this NOD. Failure to correct the deficiencies described in this NOD by the date specified shall result in the assessment of a civil penalty of fifty dollars ($50) per day for each Class B deficiency and twenty-five dollars ($25) per day for each Class C deficiency, beginning on the 31•t day after the receipt of this NOD and will continue to accrue until the date the licensee submits verification that all deficiencies are corrected or until the date a written CAP is received and approved by the Department. The date of submission by the licensee of the written verification of correction by the licensee shall be the date it is postmarked. The maximum daily civil penalty for all deficiencies shall not exceed one hundred and fifty dollars ($150) per day.

CORRECTIVE ACTION PLAN (CAP)- Title 9, Chapter 5, Section 10545, CCR, allows the licensee to submit a CAP for those Class B or C deficiencies which cannot be corrected by the date specified in the NOD. The licensee shall send a written CAP addressed to the Manager of the Programs Compliance Branch, Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814"4037, postmarked no later than the date specified in the NOD. The written CAP shall include: what steps the licensee has taken to correct the deficiency; substantiate why the deficiency cannot be corrected by the date specified in the NOD; and specify when the deficiency will be corrected. Within ten (10) days of receipt of the CAP, the Department shall notify the licensee, in writing by first class mail, whether the CAP has been approved.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HJ,RE: ___ ~--1?'--·---- PAGE:

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Slate of Calik>rnla·HHllh and Huml!n Servlees Ag1111ey ADP 7350, Revised ""09

COMPLAINT FORM This form fs Intended to document complaints recefved.

Reported 0 1n Person D By Letter or E-mail

D By FAX [2J By Phone

Complainant Name:

Address; '

City: State: Zip:

Teleohone Number(s): (

E-mail: ·,

Complainant's Relationship to Provider:

C1 - Facility Resident(s) C2 - Faclllty Start C3 - Neighbors C4 - Relative/Friend cs- Public:/Gov. Agency C6- Anonymous C7 - Former Resident ca - Fonner Staff C9-0fher *** - Unknovm

Complaint Number: 10·257

D~partme"t of Alc:oltol and Or11g Pl'Ogtams Llc.nslng and Ccnlfleatron Dhllt;lon

1700 K Str&Qt1 S:ieramento, CA 95811 TDD (1116) "'45-19421 FilX (9113) 322-2658

(9111) 322-2911

D PRIORITY

TypecflniJeit1gat1on: DEATH 'INVESTIGATION

Type or Progran,:· LIC ONl-Y

Provider License Number (If Applicable): 090018AN

Provider Legal Narne: NARCONON of Northern California

Facillty Name: NARCONON • Vista Bay

Address(s): 1364 Ruth Haven Lane

City: Placsrville Zip: 95667

County:

Contact Name: Daniel Manson

Telephone Number: (530) 295-5550

Complainant waives confidentiality of his/her name and name of any person named in complaint except provider clients. DYES (gJ NO

COMPLAINT RECORDED BY: J. lto-Orille DATE RECEIVED: February 25t 2011

COMPLETE FOR COUNSELOR: MISCONDUCT COMPLAINTS

COUNSELOR NAME CERTIFYING ORGANIZATION CERTIFICATION OR EXPIRATION OR REGISTRATION NO. RENEWAL DATE

COUNSELOR COMPLAINT (90-DAY) DUE DATE:

ALLEGATION NATURE OF COMPLAINT (REGULATION I STANDARD)

Complainant's daughter, · · was a client at the facility In - -. Cllent went ln~o the hospital In · ; and then died of a "blood clot in the lung'' after being in the hospital for about 1 week. Complainant feels that her death oecurred because of the treatment at the faclllty. Complainant stated that she is concerned that the practices of the sauna treatment.

·-···-··--··----·----·-·-· DUPLICATE OF 10-0500 D ----·--··-··-·-·---······-

;;

ASSIGNMENT INFORMATION

ASSIGNED FIELD OPERATIONS ANALYST: Michael Allen

ASSIGNED COMPLAINT INVESTIGATOR: J. Corey Sparks

INVESTIGATION FINDINGS

ALLEGATION (REGULATION I STANDARD)

RESULT CLASS

DATE COMPLAINT ASSIGNED: 2/26/2011

DATE INVESTIGATION WAS INITIATED; n/a

ALLEGATION (REGULATION I STANDARD)

RESULT

COUNSELOR MISCONDUCT COMPLAINT FINDINGS

ALLEGATION

FOLLOW-UP INVESTIGATION

RECOMMENDED CATEGORY OF FOLLOW-UP:

FOLLOW-UP VIOLATION (S) RESULTS

CLOSURE INFORMATION

INVESTIGATION COMPLETED BY: J. Corey Sparks

DATE REVIEW WAS COMPLETED: March 28, 2011

TOTAL FINES ASSESSED: 0

COMMENTS

Complaint Is a dupllcate of 10-0500

INVESTIGATING ANALYST'S SIGNATURE:

1./:f"-'1-'"'7 t ~:'v"/tf'-. i/ f

DATE;

3/28/11

RESULT ORDER

CLASS FOLLOW.UP VIOLATION (S) RESULTS

DATE OF INITIAL SITE VISIT: n/a

DATE OF FINAL REPORT: n/a

DATE CLOSED: March 28, 2011

CLASS

CLASS

·'

License & Certification

Query System Record Information

Printed at: 14:27:56 on

Record ID: 09·001aAN

BASIC-----

Fae - Name NARCONON VISTA BAY

Address 1364 RUTH HAVEN LANE

City PLACERVILLE

Phone (530}295·5550

Contact: DANIEL MANSON

Mail Addr. 262 GAFFEY ROAD

City WATSONVILLE

02/25/.2011

E:x:tn.

Provider NARCONON OF NORTHERN CALIFORNIA

Director salutation MR.

First Name DANIEL

State CA Zip 95667·

Fax (530)295-5551

Phone {B31)768·7190 Extn.

State CA Zip 95076·

Last Name (include Phd etc.) MANSON

APPL/CA TJON ---

Funding Code NFD

Structure Code

Program Code RES

Target Pop. Code 1.1

# of addresses

Closed Date: 1 Treatment Capacity 15 Total Cap.

ved Application Recei

Den ied

Withdr awn

ved Renewal Recei

Comp lete

LICENSE---~

C. A. D. D. s. #

Initial Issue D ate

Current Effective D ate

Current Expire D ate

ate Last Compl. Rev. D

Next Review D ate

License

07/26/2010

07/26/2010

11/08/2010

11/01/2004

10/01/2010

09/30/2012

09/30/2010

04101/2012

License No. 090016AN

Alcohol Cert. No.

Comments:

Alcohol

Drug Cert. No.

Combined Cert. No.

18 Prog. Duration

Drug Combined

Check# 2533 in the amount of $2,205.00 was received by ADF via USPS on 07/26/2010 for payment of Biennial Renewal Extension Fee covering from 10/01/2010 through 09/30/2012.

.::_. ·~·

Barbara Alves From: Janelle lto-Orille Sent: Friday, February 25, 2011 2:22 PM To: Barbara Alves Subject: Narconon - Vista Bay Death

Narconon -1 Bay Death.d

Barbara,

Please Jog this complaint in and give it a number and regulations.

Thank you

\ l

:. I '

... ' ·)'I" ~ ..

. .

CLOSED COMPLAINT

SUBMITTED BY: -COREY SPARKS

,• •;;,...""',.: "(""" " STAT~ OF CALIFORNIA-HEALTH ANO HUMAN SERVlC, .GE.NCY E;:OMUND G. BROWN JR., Govemor

DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS 1700 K STREET SACRAMENTO, CA 95811-4037 TDD (916) 445-1942 (916) 322-2911

February 25, 2011

RE: Complaint Investigation Number 10-2570

Dear

The Department of Alcohol and Drug Programs has received your correspondence regarding Narconon Vista Bay, located in Placerville, California. Your complaint has been assigned number 10-2570. Please refer to this complaint number when corresponding with this office.

A review of your complaint will be conducted. The Department is unable to provide any information regarding the investigation until it has concluded, your patience is greatly appreciated. Please be aware that we may need to contact you for further information.

If you have any questions or.additional information that may be relevant or helpful, please contact Barbara Alves [email protected] or by phone at (916) 445-7276.

Thank you for bringing your concerns to our attention.

Sincerely,

Barbara Alves Complaint Intake Analyst Ptogram Compliance Branch Licensing and Certification Division

00 YOUR PART TO HKP CALIFORNIA SAVE ENERGY

For energy saving tips, visit the Flex Your Power website at http://www.fypower.org

& •

State of California-Health and Human Services Agency ADP 7350, Revised 4/09

COMPLAINT FORM This form is intended to document complaints received.

Reported D In Person D By Letter or E-mail

D By FAX D By Phone

Complainant Name:

Address:

City:

Telephone Number(s):

E-mail:

Complainant's Relationship to Provide

C1 - Facility Resident(s) C2 - Facility Staff C3 - Neighbors C4 - Relative/Friend C5 - Public/Gov. Agency C6 - Anonymous C7 - Former Resident C8 - Former Staff C9-0ther *** - Unknown

Complaint Number: 10-0500

Department of Alcohol and Drug Programs Licensing and Certification Division

1700 K Street, Sacramento, CA 95811 TDD (916) 445-1942, Fax (916) 322-2658

(916)322-2911

D PRIORITY

Type of Investigation: DEATH INVESTIGATION

Type of Program: UC/CERT

Provider License Number (If Applicable): 490009CN

Provider Legal Name: Narconon of Northern California

Facility Name: Narconon of Northern California

Address(s): 262 Gaffey Road

City: Watsonville Zip: 95076

County: Santa Cruz

Contact Name: Jeff Panelli


Complainant waives confidentiality of his/her name and name of any person named in complaint except provider clients. DYES ONO

COMPLAINT RECORDED BY: M. Vasquez DATE RECEIVED: 08/12/2010

COMPLETE FOR COUNSELOR MISCONDUCT COMPLAINTS




10561(b)(1)(A) A· .::lient was enrolled in the program on J. Client died on on I

- - - - - t the hospital due to ;; ...

ASSIGNMENT INFORMATION

ASSIGNED FIELD OPERATIONS ANALYST: Marie Montiero-Gomez DATE COMPLAINT ASSIGNED: 11/6/2011 (to Alatorre)

ASSIGNED COMPLAINT INVESTIGATOR: -J:-B~parks- \ '( (\\)'.:;_ 1\Qn?'~ b !\. J-\ \_C\l()((0

DATE INVESTIGATION WAS INITIATED: 11/6/2011 L' I;,, i

INVESTIGATION FINDINGS

ALLEGATION

(REGULATION I STANDARD) RESULT CLASS

ALLEGATION

(REGULATION I STANDARD) RESULT

1.10561 (b)(1)(A) SUBSTANTIATED A 6. 10567(a} SUBSTANTIATED

2. 10561 (b)(1)(A} SUBSTANTIATED A 7.13010(a}/10563 SUBSTANTIATED

3. 12055/12050/10563 SUBSTANTIATED A 8.10564 (c} (1) SUBSTANTIATED

4. 10510 SUBSTANTIATED B

5.10569 SUBSTANTIATED A


ALLEGATION RESULT ORDER



FOLLOW-UP VIOLATION (S) RESULTS CLASS FOLLOW-UP VIOLATION (S) RESULTS

CLOSURE INFORMATION

INVESTIGATION COMPLETED BY: f '"" I ·, I---\ J-\\ n :\J\ ·~ e.) DATE OF INITIAL SITE VISIT: 11/7/2011 and 11/8/2011

DATE REVIEW WAS COMPLETED: 12/16/2011 DATE OF FINAL REPORT: 2/22/2012

TOTAL FINES ASSESSED: N/A DATE CLOSED: 3/30/2012

COMMENTS

*Notice to complainant of findings went out pursuant to CCR 10543(1).

\NV~_STJQATING ANAL YST~~Gf;J.~ TURE.;. ! 1!){, l .. I r 'l/1, ! I . / \ i, l \ I ,r' ; \ j' j -- ff ~ ,. \ ')\/ V.u\ /\J '., __ :.Y Ccl_:_j /V

DATE:

3/30/2012

SUPERVISOFfF ~.-- ~d:::

/~ I

CLASS

B

B

c

CLASS

Page 2 of 2

State of California-Health and Human Services Agency ADP 7350, Revised 4/09

COMPLAINT FORM This form is intended to document complaints received.

Reported D In Person D By Letter or E-mail

D By FAX ~ By Phone

Complainant Name:

Address:

City:

Teleohone Number(s):

E-mail:

Complainant's Relationship to Provider:

C1 - Facility Resident(s) C2 - Facility Staff C3 - Neighbors C4 - Relative/Friend C5 - Public/Gov. Agency C6 - Anonymous C7 - Former Resident C8 - Former Staff C9-0ther *** - Unknown

I /' l ( {.,{ (_/{c Jc.-/, ----

Complaint Number: 10-2570



(916) 322-2911

~ PRIORITY

Type of Investigation: DEATH INVESTIGATION

Type of Program: LIC ONLY

Provider License Number (If Applicable): 090018AN

Provider Legal Name: NARCONON of Northern California

Facility Name: NARCONON - Vista Bay

Address( s ): 1364 Ruth Haven Lane

City: Placerville Zip: 95667

County:

Contact Name: Daniel Manson


Complainant waives confidentiality of his/her name and name of any person named in complaint except provider clients. DYES ~NO

COMPLAINT RECORDED BY: J. lto-Orille DATE RECEIVED: February 25, 2011

COMPLETE FOR COUNSELOR MISCONDUCT COMPLAINTS




Complainant's , was a client at the facility in r Client

10561(b)(1)(A) went into the hospital in after being in the hospital for about Complainant feels that death occurrecfbecause of the treatment at the facility. Complainant stated that • is concerned that the practices of the sauna treatment.

- //

\ -- --ASSIGNMENT INFORMATION '

/1 . ( ; ( ASSIGNED FIELD OPERATIONS ANALYST: Michael Allen DATE COMPLAINT ASSIGNED: J ( \ l (;_ L}ff,1V~ \

ASSIGNED COMPLAINT INVESTIGATOR: DATE INVESTIGATION WAS INITIATED:

INVESTIGATION FINDINGS I I

ALLEGATION


ALLEGATION



ALLEGATION RESULT ORDER



FOLLOW-UP VIOLATION (S) RESULTS CLASS FOLLOW-UP VIOLATION (S) RESULTS CLASS

CLOSURE INFORMATION

INVESTIGATION COMPLETED BY: DATE OF INITIAL SITE VISIT:

DATE REVIEW WAS COMPLETED: DATE OF FINAL REPORT:

TOT AL FINES ASSESSED: DATE CLOSED:

COMMENTS

INVESTIGATING ANALYST'S SIGNATURE DATE: SUPERVISOR'S SIGNATURE: DATE:

Page 2 of 2

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS 1700 K STREET SACRAMENTO, CA 95811-4037 TTY/TDD (800) 735-2929 (916) 322-2911

Dear'

RE: Complaint Number 10-0500/10-2570

EDMUND G. BROWN JR .. Governor

This is in response to your correspondence of - , Narconon of Northern California, located at 262 Gaffey Road, Watsonville, CA 95076.

The Department of Alcohol and Drug Programs (ADP) conducted an investigation of the allegations you submitted and determined the outcome, as follows:

• Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's death until one year after the death of Decedent- ADP has substantiated this issue

• Licensee did not send a report of the death of Decedent until one year after Decedent's death- ADP has substantiated this issue

• Licensee did not possess policies and procedures ensuring Decedent sought timely medical treatment- ADP has substantiated this issue

• Licensee provided an inaccurate statement to the Department of Alcohol and Drug Programs- ADP has substantiated this issue

• Licensee did not ensure Decedent was afforded safe, healthful and comfortable accommodations to meet Decedent's needs- ADP has substantiated this issue

• Licensee staff did not complete the required Resident Health Screening for Decedent- ADP has substantiated this issue

• Licensee did not ensure its counseling staff was licensed, certified, or registered six months from date of hire- ADP has substantiated this issue

• Licensee failed to ensure personnel are tested for Tuberculosis annually-ADP has substantiated this issue

flex~·· "0llT ., lPom Do YOUR PART To HELP CALIFORNIA SAVE ENERGY

For energy saving tips, visit the Flex Your Power website at http://www.fvpower.org

Norma Resnick March 30, 2012 Page 2

Please be assured that ADP monitors facilities/counselors frequently to ensure they maintain compliance with residential and outpatient alcohol and/or drug facility laws, regulations, and standards.

Thank you for bringing your concerns to our attention. If you have any questions, please contact me at (916) 445-9153 or at [email protected].

~incerely, i \ ['

i··.! f'01. ) < (~~) . ·# .,/ ', : '.ii ~ ./ \ i

\~:z('~AL I . ;~~ Complaint Analyst 0 Program Compliance Branch Licensing and Certification Division

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS 1700 K STREET SACRAMENTO, CA 95811 TDD (916) 445-1942 (916) 322-2911

March 30, 2012

Daniel Mason, Director Nathan Tuddenham, Director of Administration Narconon of Northern California 262 Gaffey Road Watsonville, CA 95076

Dear Mr. Manson and Mr. Tuddenham:

NOTICE OF CLEARED DEFICIENCY -INVESTIGATION 10-0500

EDMUND G. BROWN. JR, Governor

The corrections you submitted were received on March 21, 2012 and March 1, 2012 for Narconon of Northern California, located at 262 Gaffey Road, Watsonville, California 95076, as noted on the Notice of Deficiency dated February 22, 2012. The corrections have been reviewed and approved as submitted.

Thank you for your cooperation in this matter. If you have any questions, please contact me at (916) 445-9153 or email me at [email protected].

Regards, r'\.

!~ l~i\,. (} 1 1\~ \ 1.rv l / a/'~ ~RANNA A. ALATORR • Complaint Investigator Program Compliance Branch Licensing and Certification Division

Do YOUR PART To HELP CALIFORNIA SAVE ENERGY

For energy saving tips, visit the Flex Your Power website at http://www.flexyourpower.ca.gov

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01/08



(916) 322-2911



REFERENCES: (1) Health and Safety Code Section 11834.01 and California Code of Regulations (CCR), Title 9, Section 10502. Departmental Authority to License. (2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program Certification Standards.



Overview Licensee admitted Resident#1 (Hereinafter "Decedent") to Licensee's residential treatment program on

. Decedent's first complaint of .... ·-_ occurred on · On -Decedent requested to be transported to the emergency room where Nas admitted. On

Decedent expired at the ' - .. __ .. , a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared by Dr. Steven Smith, M.D. as . _ which occurred

3 prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered Decedent's expiration.

Detailed Chronological Manifest of Decedent's Illness On . a progress note was made my staff member (nursing assistant), Emma Thomas. Emma Thomas indicated that Decedent had

". Decedent's temperature was recorded at


On at 10:30AM, Emma Thomas documented in Decedent's residential chart, ' · -- . Decedent's temperature was recorded at A . .

further notation was made "

OnJ 1 at 2:20 p.m. Emma Thomas documented in Decedent's residential chart, r_ . J_ I _ n -


On ___ J Jime not specified), Emma Thomas documented in Decedent's residential chart, "was doing • · · · · · _ Decedent's temperature was recorded at Emma Thomas further records, "Will re-check in the PM".

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:----------


PAGE:

3 of 18

NAR~ON® NORTHERN CALIFORNIA

262 Gaffey Rd. • Watsonville, CA 95076 • 800.556.8885 • ,.vww.drugrehab.net

Date: 19 March 2012

Adrianna Alatorre Complaint Investigator - Program Compliance Branch Department of Alcohol and Drug Programs 1700 K Street Sacramento, CA 95811-4037

Dear Ms. Alatorre,

Enclosed is the response for correction of deficiencies found in investigation 10-050D, findings #4, 6, 7 and 8, investigation 10-059, allegation (b ), and investigation 11-030 allegation (a) and findings #1 and 2 for Narconon of Northern California, facility license number: 440009CN. Below is an itemized explanation for each correction.

10-050D, findings #4 "Licensee provided and inaccurate statement to the Department of Alcohol and Drug Programs. "

I have written an order and dispatched it to all employees who might prepare an Unusual Incident/Injury/Death Report Form. This order details the specific steps for preparing the form in an accurate manner.

10-050D, finding #6 "Licensee staff did not complete the required Resident Health Screening for Decedent. "

I have written an order and dispatched it to all employees involved with admissions or re-admissions clarifying what paperwork is to be filled out each time a client is transferred or re-admitted.

10-050D, findings #7 "Licensee did not ensure its counseling staff was licensed, certified, or registered within six months from date of hire. " and #8 "Licensee failed to ensure personnel are tested for Tuberculosis annually. "

I have written a policy regarding the personnel calendar, what it should contain, and when reminders need to be set up to ensure that no required actions are missed.

11-030, allegation (a) "Licensee transferred Resident #Ito an unlicensed residential facility when personnel opined Resident #1 required 1 - t services.

Attached is an updated referral policy with a more comprehensive explanation of referral criteria and what type of referrals we are responsible for. I have also attached referral lists ensuring that we have appropriate resources available for

©2005 Narconon of Northern California. All rights reserved. Narconon and the Narconon logo are trademarks and service marks owned by the Association for Better Living and education International and are used with its pemrission.

program participants. This policy has been dispatched to all staff and is given to all program participants.

11-030, findings # 1 "Licensee did not produce Resident# I 's treatment file for inspection to California Department of Alcohol and Drug Programs staff" And #2 "Licensee provided an inaccurate statement to the Department of Alcohol and Drug Programs. "

The reason the file was not initially located and why an inaccurate statement was made is because our storage for archived files was too full and had become disorganized. We have since purchased an additional 10' x 40' storage container to house archived files. We have re-organized all of our files, by year, alphabetically and with master lists, to ensure that files are easily found and well organized.

10-059, allegation (b) "Licensee's program discharged Resident #I for reasons not specified in Resident# I 's admission agreement. "

I have modified our Client Rules and Responsibilities in our Admissions Agreement to reflect the reasons why Resident #1 was discharged. The modification can be found under Level III Offenses, point # 15.

Please contact me if you have any questions regarding the above corrections.

Respectfully,

Na than Tuddenham RAS Senior Director for Administration Narconon ofNorthern California (831) 740-4629 [email protected]

©2005 Narconon oi Northern Caliiorn1a. All rights reser,ed. Narconon and tr,e Narconon logo are trademarks and service marks owned by the Association for Better Living and education International and are used with its permission.




(916) 322-2911




FINDINGS

THE FOLLOWING DEFICIENCY{IES) WERE IDENTIFIED AND SUBSTANTIATED DURING THE COURSE OF ~LAS_S __ THE INVESTIGATION:

I

1.

i 2.

3.

Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's death until one year after the death of Decedent. Licensee did not send a report of the death of Decedent until one year after Decedent's death. Licensee did not possess policies and procedures ensuring Decedent sought timely medical treatment.

!

4. Licensee provided an inaccurate statement to the Department of Alcohol and Drug Programs.

! I

I

5.

6.

7.

Licensee did not ensure Decedent was afforded safe, healthful and comfortable accommodations to meet Decedent's needs.

Licensee staff did not complete the required Resident Health Screening for Decedent

Licensee did not ensure its counseling staff was licensed, certified, or registered six months from date of hire.

8. Licensee failed to ensure personnel are tested for Tuberculosis annually. B :S\ lPi t-iD

INVESTIGATIVE SUMMARY HQ)JJ/ft2{! Investigative Procedure ·/V:: Complaint Analyst (Hereinafter "CA Alatorre") made an unannounced investigative visit to Narconon of (J:-j Northern California ("Licensee") at the above address to investigate death investigation number 10-0840 ,., and complaint numbers 10-030, 10-059, 10-152, and 11-030 on November 7, 2011 and November 8, 2011, respectively.


I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:----------


PAGE:

2 of 18

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 6015L. Revised 02108



1700 K Street. Sacramento. CA 95811 TDD (916) 445-1942, Fax (916) 322-2658

(916) 322-2911


10-0500

REFERENCES (1) Health and Safety Code Section 11834.01 and California Code of Regulations (CCR), Title 9, Section 10502. Departmental Authority to License. (2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program Certification Standards.

PROGRAM/FACILITY LEGAL NAME:

Nacronon of Northern California

ADDRESS (Street, City and Zip):

262 Gaffey Road, Watsonville, CA 95076

TYPE OF INVESTIGATION:

DATE OF SITE VISIT:

November 7, 2011 and November 8, 2011

TYPE OF PROGRAM/FACILITY: (Please check all that applies)

D COMPLAINT D FOLLOW-UP

O UNLICENSED ~ DEATH

~ RESIDENTIAL O NONRESIDENTIAL

~ AOD LICENSED D DMC CERTIFIED

D DETOXIFICATION

D ADOLESCENT

D NTP D DUI

D PERINATAL

D COUNSELOR MISCONDUCT - The Counselor Investigative Report may be referred upon.

~ AOD CERTIFIED O COUNTY OPERATED O CDCR AFTER CARE PROGRAM


D NO DEFICIENCY (Licensed and/or Certified Programs)

~ DEATH INVESTIGATION (Licensed and/or Certified Programs)

~ CERTIFICATION (AOD Certified Programs)

~ NOTICE OF DEFICIENCY (Licensed Programs)


D~TERDEPARTMENTALREFERRAL

The investigation was conducted in accordance with California Code of Regulations (CCR), Title 9, Chapter 5, and/or the Alcohol and/or Other Drug

Program Certification Standards which may include the following: inspection of the program premises, review of program policies, procedures,

staff and resident file{s), and the interview of residents and staff. In addition, the complaint investigator shall notify the licensed and/or certified

program/facility director or his/her designee of the allegation{s) during the exit conference. (The ADP 9080, Detail Supportive Information form and

ADP 7025, Confidential Names form may be referred upon.)

ST SIGNATURE I - ATE v

TELEPHONE: (916 445-9153 TELEPHONE: (916)327-5693


PROGRAM/,FACILITY REPRESENTATIVE Please sign above, initial any following pages and return the original to ADP.

TELEPHONE NUMBER:

DATE

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01108




(916) 322-2911



FINDINGS

I THE FOLLOWING DEFICIENCY(IES) WERE IDENTIFIED AND SUBSTANTIATED DURING THE COURSE OF THE INVESTIGATION:

CLASS ,

1.

2.

' 3.

4.

I 5.

6.

7.

! 8.

Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's death until one year after the death of Decedent. Licensee did not send a report of the death of Decedent until one year after Decedent's death. Licensee did not possess policies and procedures ensuring Decedent sought timely medical treatment. Licensee provided an inaccurate statement to the Department of Alcohol and Drug Programs. Licensee did not ensure Decedent was afforded safe, healthful and comfortable accommodations to meet Decedent's needs.

Licensee staff did not complete the required Resident Health Screening for Decedent

Licensee did not ensure its counseling staff was licensed, certified, or registered six months from date of hire.

Licensee failed to ensure personnel are tested for Tuberculosis annually.


Investigative Procedure

A

A

A

B

A

B

B

B

Complaint Analyst (Hereinafter "CA Alatorre") made an unannounced investigative visit to Narconon of Northern California ("Licensee") at the above address to investigate death investigation number 10-0840 and complaint numbers 10-030, 10-059, 10-152, and 11-030 on November 7, 2011 and November 8, 2011, respectively.


I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: ___ ;z__~7 _____ _ Program/Faci'lity Representative

PAGE:

2 of 18

:




(916) 322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: I COMPLAINT INVESTIGATION NUMBER: 440009CN Narconon of Northern California 10-0500 REFERENCES: (1) Health and Safety Code Section 11834.01 and California Code of Regulations (CCR), Title 9, Section 10502. Departmental Authority to License.

(2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program Certification Standards.



Overview Licensee admitted Resident#1 (Hereinafter "Decedent") to Licensee's residential treatment program on

Decedent's first complaint of occurred on . On ' _ Decedent requested to be transported to the emergency room where J was admitted. On

:Jecedent expired at the ., a certificate of death was signed by Dr. Steven Smith,

M.D. The cause of death was declared by Dr. Steven Smith, M.D. as J which occurred prior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered

: to Decedent's expiration.

Detailed Chronological Manifest of Decedent's Illness _ . a progress note was made my staff member (nursing assistant), Emma Thomas.

Emma Thomas indicated that Decedent had"' J Decedent's temperature was recorded at ·


On

- . further notation was made "If f

Emma Thomas documented in Decedent's residential chart, Decedent's temperature was recorded at

.: possible ER" .

On ,I . Emma Thomas documented in Decedent's residential chart, " · · · ··re-check around dinner''.

.A


On. (time not specified), Emma Thomas documented in Decedent's residential chart, "was I, but is starting to ft . "Decedent's temperature was recorded at

Emma Thomas further records, "Will re-check in the PM".

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: __ /;t-_~ _ _..,,_/ ______ _ Program/Facility Representative

PAGE:

3 of 18




(916) 322-2911

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: I PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California l COMPLAINT INVESTIGATION NUMBER:

10-0500 REFERENCES: (1) Health and Safety Code Section 11834.01 and California Code of Regulations (CCR), Title 9, Section 10502. Departmental Authority to License.


On~' · ,., Registered Nurse Christina Kuzio, RN/HCO (Registered Nurse/Health Care Officer) documented in r (

CA Alatorre did not locate a of

!"-

f

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:------------


PAGE:

4 of 18

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 601 SL, Revised 01/08

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: PROGRAM/FACILITY NAME: 440009CN Narconon of Northern California

Department of Alcohol and Drug Pro\ Licensing and Certification Di·

1700 K Street, Sacramento, CA TDD (916) 445-1942, Fax (916) 32,

(916) 322

COMPLAINT INVESTIGATION NUMBE



when the students (residents) are integrated into the sauna portion of the program. A student cannot continue to the next book until they have completed book two unless medical conditions dictate they are ineligible to participate in that portion of the program. SDA Tuddenham confirmed Decedent was past book two of the program. Decedent's program and medical records confirmed Decedent was past book two and already successfully completed the sauna portion of the program.. ·


At approximately 1100 hours, CA Alatorre proceeded to ask Registered Nurse Christina Kuzio her recollection of the condition of the Decedent at Licensee's facility prior to the Decedent being transportec to the local emergency hospital. At which time, Registered Nurse Christina Kuzio stated "I've been arour long enough to know when I need to have representation and what I need to do to protect my license. I will not speak to you without representation present." At which time, CA Alatorre concluded the interview and continued to tour the facility. CA Alatorre advised SDA Tuddenham that CA Alatorre would not objec to allowing Registered Nurse Christina Kuzio's legal representation be present during an interview, but C1 Alatorre did need to ascertain what Registered Nurse Christina Kuzio's observations of the Decedent wer in order to complete CA Alatorre's investigation.

At approximately 1600 hours, SDA Tuddenham informed CA Alatorre that Registered Nurse Christina Kuzio was willing to speak with her without legal counsel present. Registered Nurse Christina Kuzio statec that she did not initially understand the purpose of CA Alatorre's visit and where CA Alatorre was from. CA Alatorre advised Registered Nurse Christina Kuzio that CA Alatorre did not object to her having counsel present and her waiver of such was of Registered Nurse Christina Kuzio's own informed consent Registered Nurse Christina Kuzio thereafter acknowledged CA Alatorre's statement and cooperated with CA's investigation and interview. CA Alatorre asked Registered Nurse Christina Kuzio what her recollection of Decedent was. Registered Nurse Christina Kuzio confirmed that she did recall Decedent and recalled that multiple advisements were provided to the Decedent that _ should go to a hospital if

did not feel well. Registered Nurse Christina Kuzio relayed Decedent fervently refused as Decedent did not .: which made it • onerous for Decedent to seek treatment. Registered Nurse Christina Kuzio stated that the Decedent was closely monitored and was seen by a nurse practitioner that works with the program. Registered Nurse Christina Kuzio stated that the nurse practitioner had prescribed the Decedent prescription and told the Decedent that if conditio worsened to go the emergency room. Registered Nurse Christina Kuzio further stated the death of the Decedent was "the only time something like this has happened". Registered Nurse Christina Kuzio and SDA Tuddenham both acknowledged there was not a written policy concerning potential imminent illness and injury at the time of Decedent's expiration. CA Alatorre asked Registered Nurse Christina Kuzio if thE Decedent was in the Sauna portion of program. Registered Nurse Christina Kuzio confirmed the

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE:--#______,,__ _____ _

Program!Facility Representative

PAGE:

6 of 18

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ADP 6015L, Revised 01108

Department of Alcohol and Drug Pr, Licensing and Certification C

1700 K Street, Sacramento, Ct TDD (916) 445-1942, Fax (916) 3;

(916) 3,

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: PROGRAM/FACILITY NAME: COMPLAINT INVESTIGATION NUMB

10-0500 440009CN Narconon of Northern California REFERENCES: ( 1) Health and Safety Code Section 11834.01 and California Code of Regulations (CCR), Title 9, Section 10502. Departmental Authority to License.

(2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program Certification Standards. ·

Decedent was not in the Sauna portion and that the decedent was many books (steps) past that phase the program. Registered Nurse Christina Kuzio confirmed that the nursing assistant, Emma Thomas, is longer employed at Narconon of Northern California.

1.


REGULATORY AND/OR CERTIFICATION STANDARD REOUIREMENT(S): California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, Subchapter 3, Artie! 2, §10561, Reporting Requirements provides, in part:

" ... (b) Upon the occurrence of any of the events identified in Section 10561 (b) (1) of this subchapter the licensee shall make a telephonic report to department licensing staff within one (1) working day. The telephonic report is to be followed by a written report in accordance with Section 10561 (b) (2) of this subchapterto the department within seven (7) days of the event. If a report to local authorities exists which meets the requirements cited, a copy of such a report will suffice for the written report required by the department ... "


SUMMARY: Licensee admitted Decedent to Licensee's residential treatment program on Decedent's first complaint of occurred on . , Decedent requested and was transported to the emergency room where was admitted. On

Decedent expired at the hospital intensive care unit. On , a certificate of death was signed by Dr. Steven Smith, M.D. The cause of death was declared as _ _

which occurred' . ;)rior to Decedent's expiration. Dr. Steven Smith, M.D. further noted that the Decedent suffered · , prior to decedent's expiration.

On August 12, 2010, Marie Montiero, Field Operations Branch Analyst with the Department of Alcohol and Drug Programs (ADP), contacted Jeff Panelli, Senior Director of Administration at Narconon of Northern California (Hereinafter "SDA Panelli"), to inquire about Decedent's death.

SDA Panelli told Ms. Montiero that there was a death at the facility; however it was over a year ago. SDA Panelli further stated that because the death did not happen at the facility, it was not reported to ADP.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: --~-~_-_v.77 ______ _


PAGE:

7 of 18



Department of Alcohol and Drug Prog Licensing and Certification Di~

1700 K Street, Sacramento, CA £ TDD (916) 445-1942, Fax (916) 322

(916) 322·

COMPLAINT INVESTIGATION NUMBE

10-0500 REFERENCES: (1) Health and Safety Code Section 11834.01 and California Code of Regulations (CCR). Title 9, Section 10502. Departmental Authority to License.



Upon review oft i('onsee's files, CA Alatorre observed staff member. personnel file. personnel file reflects that _ 's first

. ___ .,,,s next conducted one year and one month later (13 months later) on 1

-

Based on review of employee _ __ ____ _ 's personnel file, Licensee is noncompliant with CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, §10564(c) (1 ).

NOTICE OF DEFICIENCY - It is important that the licensee complies with regulations and the instructions of this Notice of Deficiency. Failure of the licensee to comply may result in other. possible enforcement actions, such as license suspension or revocation. ·

-- - • -- = -' -- a - - ,• ,• -

NOTICE OF DEFICIENCY (FOR VIOLATION OF. CCR, TITLE 9, CHAPTER 5 SECTION 10500 et seq. - The licensee shall submit written verification of correction for the Class AdMic::iency(ies) identified in this notice of deficiency to ADP within 10 days of receipt of the notice.ofdeficiency. The wrltten · . ·. Verification shall substantiate that the deficiency(ies) have beencorrected a11d Specify the datewhen thE defidency(ies) were corrected. If the licenseE3. cannot_ correct the deficiency(ies)~ithin 10 days of . receipt ofthis notice, the licensee shall submita written CorrecUveAction Plan (CAPJto: Manager, - . ProgramCompliance Branch, Departmentof Alcohol ahd DrugPrograrns, Licensing and Gertification .. Division, 1700 KStreet,> Sacramento, CA 95811-4037, "The CAP shall indud~ what steps thelicensee has taken to correct the deficiency(ies ); substantiate why the deficien~y(ies) cannot be corrected as .. specified in this notice; and specify whenthedeficiency will be.corrected. The.v.,titten vE!rification.of correction or 'Nritten CAP shall be postmarked. no later than the date(s) specffiedjn thisnotice. The licensee shaHsubmit written verificatiOn of correction for.the Class B and c deficiency(ies) identified in this notice of deficiency to ADPwithin 30 days of receiptof the .notice of defid~ncy.:lf the licen.see cannot correctthe deficiency(ies) within 30 daysof receiptof this notice;th'3ncenseeshan submit a written Corrective Action Plan (CAP) to:. Manager, Program COmpljance Bra11ch)Q~partment ofAlcohol and Drug Programs, Licensing and Certification Division;-1700. K Street, Sacra1Jleilto;"CA95811-4037: The CAP shall include what steps the licensee has taken to correct the deffciE!hcy(ies ); substantiate why the deficiency(ies)carinot be corrected as specifiedin this notice; ahd specify when the deficiencywill· be corrected. The written verification of correction or written CAP shall be postmarked no later than the date(s) specified in this notice. · · · · .· · · · ·

Penalt : Failure to correct the above cited deficienc ies shall result in the assessment of a civil ·

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: k-0 7 Program/Facnity Representative

PAGE:

16 of 18


Department of Alcohol and Drug Pro, Licensing and Certification Oil

1700 K Street, Sacramento, CA ! TDD (916) 445-1942, Fax (916) 322

(916) 322


COMPLAINT INVESTIGATION NUMBE 10-0500


penalty of $50 per day for each Class Adeficiency, beginning on the 11 day after receiving .this notice and will continue to accrue until the date~ the Hcensee submits verifi9auon that the deficiency(ies) are corrected br until the date a written CAP is received and approved;. The date of submission by the licensee ofthe written verification ofcorrecticin, or the written CAP, shall be the date that it is postmarked . . The ma)(imum d~ilycivil penaltyfor'the deficiency(ies) shaU_not exceed.one hundredanc fifty dollars{$J50) pefday. - ·. · .· • . · .· . . . _· .. . . . · . . ·. . · _ Failure t9 cqrrect the above cited deficiency(ies) shall result in the assessment of a civil penalty of $50 perctay for each Class Bdefidency(ies)and $25 per day for each.Class C deficiency(ies ), beginning On the 31st day after receiving this notice and will continue to accrue t.mtil the date theiicensee_submits verification that the defidency(ies) are correded qr until the date a written CAP is received and . -approved.· The date of submission by the licensee ofthe written ve-rification of correction; or the written

. CAP, shall he the date that it is postmarked. The maximum daily civil penalty for the deficiericy(ies). shall not exceed one hundred and fift dollars $150 er da . ·


IT IS IMPORTANT THAT THE PROGRAM/FACILITY COMPLY WITH THE CALIFORNIA CODE OF REGULATIONS (CCR), TITLE 9.

* * *

NOTICE OF DEFICIENCY - Title 9, Chapter 5, Sections 10543 & 10544, of the California Code of Regulations (CCR), requires the Department complaint investigator/reviewer to prepare a written NOD at the completion of each complaint investigation/licensing compliance review listing all deficiencies noted. The NOD is made a part of the licensing records for the facility and the licensing agency, and is available for public review. Care is taken not to disclose any confidential information in the report. Inquiries concerning the location, maintenance, and content of these reports may be directed to the Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814-4037.

DEFICIENCIES - A deficiency is a failure to comply with any provision of the regulations pursuant to Chapter 7.5 of Part 2 of Division 10.5 of the Health and Safety Code. The NOD shall specify: the section number, title, and code of each statute or regulation which has been violated; the manner in which the licensee has failed to comply with a specified statute or regulation, and the particular place or area of the facility in which it occurred; the date by which each deficiency shall be corrected; amount of the civil penalty to be assessed in accordance with Title 9, Chapter 5, Sections 10547, CCR, and the date the Department shall begin to assess the penalty, if the licensee fails to correct the noticed deficiencies or submit a CAP.

WRITTEN NOTIFICATION TO DEPARTMENT - The licensee shall submit to the Department written verification of correction for each deficiency identified in this notice of deficiency (NOD). The written verification shall substantiate that the deficiency has been corrected and specify the date when the

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: __ ,,A_n..,_J~, ------/ 17of18


PAGE:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY ADP 601 SL, Revised 01108

Department of Alcohol and Drug Pre Licensing and Certification D

1700 K Street, Sacramento, CA TDD (916) 445-1942, Fax (916) 32

(916)32

PROGRAM INVESTIGATIVE REPORT PROGRAM/FACILITY ID NUMBER: PROGRAM/FACILITY NAME:

440009CN Narconon of Northern California COMPLAINT INVESTIGATION NUMB



deficiency was corrected. If the licensee cannot correct a deficiency within the days specified in this NOD, the licensee shall submit a written CAP to: Manager, Programs Compliance Branch, Department Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 9581, The CAP shall include what steps the licensee has taken to correct the deficiency (ies); substantiate wr

the deficiency cannot be corrected as specified in this NOD; and indicate the specific date when the deficiency (ies) will be corrected. The written verification of correction or written CAP shall be postmarkE no later than the date specified in this NOD.



ALL OTHER DEFICIENCIES - The licensee shall submit to the Department written verification of correction for each deficiency identified in this NOD within thirty (30) days of receiving this NOD. Failure to correct the deficiencies described in this NOD by the date specified shall result in the assessment of a civil penalty of fifty dollars ($50) per day for each Class B deficiency and twenty-five dollars ($25) per day for each Class C deficiency, beginning on the 31st day after the receipt of this NOD and will continue to accrue until the date the licensee submits verification that all deficiencies are corrected or until the date a written CAP is received and approved by the Department. The date of submission by the licensee of the written verification of correction by the licensee shall be the date it is postmarked. The maximum daily civil penalty for all deficiencies shall not exceed one hundred and fifty dollars ($150) per day.

CORRECTIVE ACTION PLAN {CAP)- Title 9, Chapter 5, Section 10545, CCR, allows the licensee to submit a CAP for those Class B or C deficiencies which cannot be corrected by the date specified in the NOD. The licensee shall send a written CAP addressed to the Manager of the Programs Compliance Branch, Department of Alcohol and Drug Programs, Licensing and Certification Division, 1700 K Street, Sacramento, CA 95814-4037, postmarked no later than the date specified in the NOD. The written CAP shall include: what steps the licensee has taken to correct the deficiency; substantiate why the deficiency cannot be corrected by the date specified in the NOD; and specify when the deficiency will be corrected. Within ten (10) days of receipt of the CAP, the Department shall notify the licensee, in writing by first class mail, whether the CAP has been approved.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION. PLEASE INITIAL HERE: ___ ~ __ ? ____ _ /


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