State of California-Health and Human Services Agency

ADP 7350, Revised 4/09

COMPLAINT FORM
This form is intended to document complaints received.
Reported DIn 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- Other *** -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: LIC/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
Telephone Number: (831) 768-7190
Complainant waives confidentiality of his/her name and name of any person named in complaint except provider clients.
DYES 0No
COMPLAINT RECORDED BY: M. Vasquez DATE RECEIVED: 08/12/2010
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)
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
4
ASSIGNED FIELD OPERATIONS ANALYST: Marie Montiero-Gomez DATE COMPLAINT ASSIGNED: 11/6/2011 (to Alatorre)
ASSIGNED COMPLAINT INVESTIGATOR: \ '( b DATE INVESTIGATION WAS INITIATED: 11/6/2011 L'
t'l
)
1\. 1-\ \_C\ Cy(0
INVESTIGATION FINDINGS
ALLEGATION
(REGULATION I STANDARD)
RESULT CLASS
ALLEGATION
(REGULATION I STANDARD)
RESULT CLASS
1.10561 (b)(1)(A) SUBSTANTIATED A 6. 10567(a} SUBSTANTIATED B
2. 10561 (b)(1)(A} SUBSTANTIATED A 7.13010(a}/10563 SUBSTANTIATED B
3. 12055/12050/10563 SUBSTANTIATED A 8.10564 (c) (1} SUBSTANTIATED c
4. 10510 SUBSTANTIATED B
5.10569 SUBSTANTIATED A
COUNSELOR MISCONDUCT COMPLAINT FINDINGS
ALLEGATION RESULT ORDER
FOLLOW-UP INVESTIGATION
RECOMMENDED CATEGORY OF FOLLOW-UP:
FOLLOW-UP VIOLATION (S) RESULTS CLASS FOLLOW-UP VIOLATION (S) RESULTS CLASS
CLOSURE INFORMATION
INVESTIGATION COMPLETED BY:
i'
" I \ DATE OF INITIAL SITE VISIT: 11/7/2011 and 11/8/2011
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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 1 0543(1).
ANAL TURE.;. DATE:
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! (ZKl . I [ il;/ I / 3/30/2012

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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 0 In Person 0 By Letter or E-mail
D By FAX 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- Other *** -Unknown
/ /; / (
!A (_/{ c h.-/,
----
Complaint Number: 10-2570
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

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
Telephone Number: (530) 295-5550
Complainant waives confidentiality of his/her name and name of any person named in complaint except provider clients.
DYES
COMPLAINT RECORDED BY: J. lto-Orille DATE RECEIVED: February 25, 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 ' 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 occurrecfoe"Ciwse of the treatment at
the facility. Complainant stated that ' is concerned that the practices of the sauna treatment.
- ./
\
-
-
ASSIGNMENT INFORMATION
'
/)
. (
; (
ASSIGNED FIELD OPERATIONS ANALYST: Michael Allen DATE COMPLAINT ASSIGNED:
J
( \
l
(;_
\
ASSIGNED COMPLAINT INVESTIGATOR: DATE INVESTIGATION WAS INITIATED:
INVESTIGATION FINDINGS
I I
ALLEGATION
(REGULATION I STANDARD)
RESULT CLASS
ALLEGATION
(REGULATION I STANDARD)
RESULT CLASS
COUNSELOR MISCONDUCT COMPLAINT FINDINGS
ALLEGATION RESULT ORDER
FOLLOW-UP INVESTIGATION
RECOMMENDED CATEGORY OF FOLLOW-UP:
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:
TOTAL 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 1 0-050D/1 0-257D
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
f l x ~
"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 Adrianna.Aiatorre@adp.ca.gov.

i \ ['
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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
TOO (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 10-050D
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 Adrianna.Aiatorre@adp.ca.gov.
Regards, r'\.
~ ~ ~ ~ \ (} I 1 \ ~
\ J.rv l / a / ~
'A-ISR ANNA A. ALA TORR

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://W#W.flexyourpower.ca.gov
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015l, Revised 01/08
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
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.
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 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
CA Alatorre did not locate a progress note for Decedent for
On at 1 0:30AM, 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_ . l_ ' _" _
CA Alatorre did not locate a progress not for Decedent for the recheck that was to occur on the evening of
On ___ J Jime not specified), Emma Thomas documented in Decedent's residential chart, llwas
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:----------
Program/Facility Representative
PAGE:
3 of 18
N A R ~ O N
NORTHERN CALIFORNIA
262 Gaffey Rd. Watsonville, CA 95076 800.556.8885 \NWw.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 ofNorthern California, facility license
number: 440009CN. Below is an itemized explanation for each correction.
1 0-050D, 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.
1 0-0SOD, 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.
1 0-050D, 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,
Nathan Tuddenham RAS
Senior Director for Administration
Narconon ofNorthern California
(831) 740-4629
nate@drugrehab.net
2005 Narconon oi Northern Caliiorn1a. All rights reserJed. Narconon and tt,e Narconon logo are trademarks and service marks owned by
the Association for Better Living and education International and are used with its permission.
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01/08
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
PROGRAM INVESTIGATIVE REPORT
PROGRAM/FACILITY ID NUMBER: 1 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.
FINDINGS
THE FOLLOWING DEFICIENCY{IES) WERE IDENTIFIED AND SUBSTANTIATED DURING THE COURSE OF __
1
THE INVESTIGATION: :
1.
Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's
A
91'
death until one year after the death of Decedent.
i
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
f)
medical treatment.
!
4.
Licensee provided an inaccurate statement to the Department of Alcohol and Drug
B

Programs. J
:
Licensee did not ensure Decedent was afforded safe, healthful and comfortable
i
5.
accommodations to meet Decedent's needs.
A C:
6. Licensee staff did not complete the required Resident Health Screening for Decedent B
3J
7.
Licensee did not ensure its counseling staff was licensed, certified, or registered six

months from date of hire.
0.
I
I
8. Licensee failed to ensure personnel are tested for Tuberculosis annually.
INVESTIGATIVE SUMMARY
83\1'
'!: 9
/,/6

Investigative Procedure /V::
Complaint Analyst (Hereinafter "CA Alatorre") made an unannounced investigative visit to Narconon of 0-i
Northern California ("Licensee") at the above address to investigate death investigation number 1 0-084D "
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:----------
Program/Facility Representative
PAGE:
2 of 18
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L. Revised 02108
PROGRAM INVESTIGATIVE REPORT
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
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.
PROGRAM/FACILITY LEGAL NAME: DATE OF SITE VISIT:
Nacronon of Northern California November 7, 2011 and
November 8, 2011
ADDRESS (Street, City and Zip):
262 Gaffey Road, Watsonville, CA 95076
TYPE OF INVESTIGATION:
D COMPLAINT D FOLLOW-UP
0 UNLICENSED
TYPE OF PROGRAM/FACILITY: (Please check all that applies)
RESIDENTIAL 0 NONRESIDENTIAL
AOD LICENSED D DMC CERTIFIED
D DETOXIFICATION
D ADOLESCENT
D NTP D DUI
D PERINATAL
0 COUNSELOR MISCONDUCT- The Counselor
Investigative Report may be referred upon.
AOD CERTIFIED 0 COUNTY OPERATED 0 CDCR AFTER CARE PROGRAM
THE FOLLOWING INVESTIGATIVE REPORT IS BEING ISSUED AS A RESULT OF THE INVESTIGATION:
D NO DEFICIENCY (Licensed and/or Certified Programs)
INVESTIGATION (Licensed and/or Certified Programs)
(AOD Certified Programs)
OF DEFICIENCY (Licensed Programs)
0 NOTICE OF OPERATION IN VIOLATION OF LAW (Unlicensed Programs)

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.)
ATE
TELEPHONE: (916)327 -5693
I HAVE READ THE PROGRAM INVESTIGATIVE REPORT AND I UNDERSTAND MY
APPEAL RIGHTS.
PROGRAM/,FACILITY REPRESENTATIVE
Please sign above, initial any following pages and return the original to AOP.
TELEPHONE NUMBER:
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01108
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
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.
FINDINGS
r THE FOLLOWING DEFICIENCY(IES) WERE IDENTIFIED AND SUBSTANTIATED DURING THE COURSE OF
CLASS
THE INVESTIGATION:
Licensee did not notify the Department of Alcohol and Drug Programs of Decedent's
1. A
death until one year 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.
Licensee provided an inaccurate statement to the Department of Alcohol and Drug
4. B
Programs.
Licensee did not ensure Decedent was afforded safe, healthful and comfortable
I
5.
accommodations to meet Decedent's needs.
A
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 1 0-084D
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: ___ ;z__--::-7 _____ _
Program/Facility Representative
PAGE:
2 of 18
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STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01/08
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
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.
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 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 .1
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
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
CA Alatorre did not locate a progress note for Decedent for
On
- .
further notation was made "Iff
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
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
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: __ .,r;t._-;?_'-.1_,_/ ______ _
Program/Facility Representative
PAGE:
3 of 18
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01/08
Department of Alcohol and Drug Programs
Licensing and Certification Division
1700 K Street, Sacramento, CA 95811
TOO (916) 445-1942, Fax (916) 3222658
(916) 322-2911
PROGRAM INVESTIGATIVE REPORT
PROGRAM/FACILITY 10 NUMBER: I PROGRAM/FACILITY NAME: l 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.
O n ~ ,., 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:------------
Program/Facility Representative
PAGE:
4 of 18
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, 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) 32:0
(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.
(2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program 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..
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 11 00 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 transportee
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 conditior
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:--#______,,__ _____ _
ProgramJFacility Representative
PAGE:
6 of 18
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01108
Department of Alcohol and Drug Pn
Licensing and Certification [
1700 K Street, Sacramento, Ct
TOO (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.
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, Artie!
2, 1 0561, 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 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
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' _ r')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: ______ _
Program/Facility Representative
PAGE:
7 of 18
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01/08
PROGRAM INVESTIGATIVE REPORT
PROGRAM/FACILITY ID NUMBER: PROGRAM/FACILITY NAME:
440009CN Narconon of Northern California
Department of Alcohol and Drug Prog
Licensing and Certification
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.
(2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program Certification Standards.
SUMMARY:
CA Alatorre randomly reviewed Licensee's personnel files to audit compliance with California
Code of Regulations, Title 9, Chapter 5, Subsection 2, 1 0500, et seq.
Upon review oft files, CA Alatorre observed staff member.
personnel file. personnel file reflects that _ 's first
. ___ ... ls next
conducted one year and one month later (13 months later) on
Based on review of employee _ - ____ _ 's personnel file, Licensee is noncompliant with
CCR, Title 9, Division 4, Chapter 5, Subchapter 3, Article 2, 1 0564(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.
_- - -- = - _- - - - - -
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 ClassAdefigiency(ies) identified in
this notice of deficiency to ADP within 10 days of receiptof thenotice.ofdeficiency. Thewrltten . .
verification shall substantiate that the deficiency(ies) have beencorrected alld specify the datewhen thE
deficiency(ies) were corrected. If the licenseE3. cannot correct the 1 Oda"yis of .
receipt ofthis notice, the licensee shall submita written Corrective Action Plan (CAP} to: Manager, - .
Program Compliance Branch, Departmentof Alcohol and DrugPrograrns, Licensing and Gertification
Division, 1700 KStreet,> Sacramento, CA 95811-4037; "The CAP shall includE? what steps thelicensee
has taken to correct the deficiency(ies);substantiate why the cannot be corrected as
specified in this notice; and specify whenthedefiCiency will be.corrected. The_\yritten VE!rification.of
correction or 'Nritten CAP shall be postmarked. no later than the date(s) specified in thisnotice. The
licensee shaHsubmit written verificatiOn of correction for-the Class Band Cdeficiency(ies) identified in
this notice of deficiency to ADPwithin 30 days of receiptof the notice of the licensee
cannot correctthe deficiency(ies) within 30 daysof receiptof thisnotice; th(31icenseeshall submit a
written Corrective Action Plan (CAP) to:. Manager, Program ofAicohol
and Drug Programs, Licensing and Certification Division; -1700. K Street, Sacrcl!Jleilto;'CA95811-4037:
The CAP shall includewhat steps the licensee has taken to correct the deflciE!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-v 7
Program/FacJI'ity Representative
PAGE:
16 of 18
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01/08
Department of Alcohol and Drug Pro
Licensing and Certification Oil
1700 K Street, Sacramento, CA !
TOO (916) 445-1942, Fax (916) 322
(916) 322
PROGRAM INVESTIGATIVE REPORT
PROGRAM/FACILITY ID NUMBER: PROGRAM/FACILITY NAME:
440009CN Narconon of Northern California
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.
(2) Health and Human Services Agency, Department of Alcohol and Drug Programs, Alcohol and/or Other Drug Program Certification Standards.
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 the licensee submits verifi9ation thatthedeficiency(ies) are
corrected or until the date awritten CAP is received and The date of submission by the
licensee ofthe written verification ofcorrection, or the written CAP, shall be the date that it is
postmarked . . The ma)(imum penaltyforthe deficiency(ies) shall.not exceed.one hundredanc
fifty dollars{$150) pefday. - . . . . . . . . .. . . . . . . . _
Failure tp cqrrect the above cited deficiency(ies) shall result in the assessment of a civil penalty of $50
perday for each Class Bdefidency(ies)al"ld$25 per day for each. Class C deficiency(ies), beginning On
the 31st day after receiving this notice and will continue to accrue until thedatethelicenseesubmits
verification that the deficiency(ies) are corrected qr until the date a written CAP is received and -
approved. Thedateofsubniission by the licensee ofthewritten ve-rification of correction; or the written
. CAP, shall he the date that it is postmarked. The maximum daily civil penalty for the deficieocy(ies).
shall not exceed one hundred and fift dollars $150 erda .
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 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: __ ------
7 17of18
Program/Facility Representative
PAGE:
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY
ADP 6015L, Revised 01108
PROGRAM INVESTIGATIVE REPORT
PROGRAM/FACILITY 10 NUMBER: PROGRAM/FACILITY NAME:
440009CN Narconon of Northern California
Department of Alcohol and Drug Pre
Licensing and Certification D
1700 K Street, Sacramento, CA
TDD (916) 445-1942, Fax (916) 32
(916)32
COMPLAINT INVESTIGATION NUMB
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.
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.
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 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 (1 0) 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: ~ I : Z
Program/Facility Representative
PAGE:
18 of 18