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County officials, in a previously unreported letter, expressed “serious” concerns early this year that a lack of oversight and care by a contractor was putting people at risk in a residential treatment center for people recovering from mental health crises.
The concerns centered on a 15-bed facility in Orange called TREEhouse, which is operated by Telecare Corporation on a county contract.
Among the issues the county cited in its January letter were a lack of activities and oversight of residents, which officials said led to boredom, an uptick in drug use, residents leaving the facility without permission, a dog bite injury, and an attempted suicide in front of other residents with a bottle obtained outside the facility.
“[The county Health Care Agency] has observed what appears to be a general lack of attention to the residents from [Telecare’s] Program Director and staff,” county officials wrote in their letter, which Voice of OC obtained through the California Public Records Act.
Group sessions did not have clinical medical professionals and were more focused on chores than recovery, the county wrote. An incoming female resident was asked by a male staffer to take off her clothes and put them into a bedbug oven. And county officials said they received “disturbing” allegations of rape by a staff member.
The employee was placed on leave and left his job five days later, according to Telecare. A year after the August 2018 report, the case is under an active criminal investigation by the Sheriff’s Department.
County officials wrote in their Jan. 9 letter they had previously brought up these issues to Telecare – including concerns about preventing abuse of residents – but that the company had not yet resolved them.
“Due to the serious nature of the issues listed above and our concern for the well-being of residents at the facility,” Telecare “must” submit a detailed plan within 30 days for how it will fix the issues, county officials wrote.
Under the contract terms, the county could have canceled the $1.9 million per year agreement if it believed Telecare wasn’t living up to its responsibilities.
A Telecare spokesman said the company did not dispute the county’s letter, and responded by fixing the issues through a plan it sent the county in February.
“Telecare has accepted the issues in the letter, and created a corrective action plan to address them,” said the spokesman, David Olson. “The county found that certain programs could be enhanced and improved, and Telecare and TREEhouse agreed with that.”
“The good news is the facility continues to do what it has always done, which is successfully treat very, very complex patients.”
Seven months after raising the concerns, county officials told Telecare in an Aug. 12 email that the company had implemented the plan and addressed the county’s concerns “to our satisfaction.”
“We’re very proud of that,” Olson said.“The creation and implementation of the corrective action plan speaks to leadership’s commitment and skill in moving forward.”
“They were successful and immediately made any changes that were asked,” said Annette Mugrditchian, the Health Care Agency’s chief of operations for behavioral health services.
A ‘Lack of Structure and Programming’
In their letter this January, county officials said Telecare’s staff were fostering long periods of unproductive time at TREEhouse.
“Although there have been some recent attempts to address some of our concerns, there is still [a] general lack of structure and programming at the facility that is creating an environment in which the residents are left with excessive amounts of unproductive time,” county officials wrote.
“This lack of programming and oversight of the residents is resulting in boredom, negative incidents, an increase in drug use at the facility and AWOLs,” the county continued, referring to residents leaving without permission.
“There were three AWOLs reported in September, four in October, and one in November. In December, one resident sustained a dog bite to the nose and another resident attempted suicide in front of other residents using a bottle he retrieved from outside the facility. [The Health Care Agency] believes both of these incidents may have been avoided if proper oversight and supervision were in place.”
Telecare’s staff at the facility “should know all residents by name, be aware of their clinical status and individual issues, and should demonstrate an interest in engaging with, attending to and assisting them with taking individual control of their personal well-being,” the county wrote.
Telecare apparently did not have any event calendar or “planned monthly cultural activities for the residents,” county officials wrote. The first group activities each day weren’t until 10:30 a.m., the county wrote.
“Some residents were sleeping or staying in their rooms until 10:00 a.m. or later. Although this is a voluntary program, we strongly believe that participation in the programming, once accepted to the program, should not be voluntary,” the county wrote.
In response, Telecare promised to hold more daily events and activities, starting with an 8 a.m. wake-up “where staff engage individuals, encouraging and providing positive support to starting the day.” Telecare said it also would post a calendar for the next three months on a white board in the dining area.
County officials expressed concern that group sessions were “lasting only seven to fifteen minutes” and that there were “no clinical or processing groups taking place.”
The group sessions that did take place “seem to be more focused on dinner and assignment of chores rather than addressing the needs of the residents and assisting them with their treatment and recovery,” the county wrote.
“Group sessions should be facilitated by a clinician, with the exception of one or two peer led groups per week that are…instructional in nature, or where they share their story of hope and recovery,” the county wrote. Officials urged Telecare to develop more group sessions, including “planned recreational activities, nature walks and computer labs.”
Telecare responded by promising, among other changes, to provide grouping sessions led by clinicians, as well as “one-on-one coaching or therapy sessions,” and to have staff facilitate activities like “nature walks, bird watching, visiting the Laguna tide pools, local museums, and local arboretums.”
Male Staffer Asking A Female Resident to Undress for Bed
The county letter also raised concerns about an incident where a resident moving in to TREEhouse “was asked to disrobe by a male staff member to put her clothes into the bedbug oven.”
“The resident asked to leave the program before being admitted,” the county wrote.
Health Care Agency officials said they questioned Telecare’s policies for welcoming new residents and how the bedbug policy was applied “unilaterally without any apparent regard for gender, trauma history, age, or individual‘s unique situation.”
County officials asked Telecare to “re-examine these policies” to be take into account each resident’s clinical needs.
Telecare responded by saying its staff would work to understand if an incoming resident has concerns about the bedbug warmer process. “If the new resident is fearful or expresses significant concerns regarding the bedbug warmer, staff will pursue options to support the individual through the process,” Telecare wrote.
Assault Allegation Remains Under Criminal Investigation
County officials wrote they “received disturbing reports from two residents of alleged sexual assault and rape by a staff member.”
“We need to ensure that you are doing everything possible to eliminate the possibility of any abuse or victimization of our residents from occurring and we are not yet satisfied with the response we have received from Program staff,” the county wrote.
“[The Health Care Agency] needs a clear report on the resolution of this matter, including what steps have been taken with this staff member to ensure he is not employed in any further Telecare programs, what could have been done differently and what will be changed, including any changes in hiring practices and monitoring of staff, in order to address this issue.”
In response, Telecare said the allegations were reported to its management on Aug. 19, 2018 and were promptly dealt with, including by contacting law enforcement.
The employee “was immediately placed on administrative leave,” and did not meet with the company “after several attempts to contact” him,” Telecare wrote. He left employment five days after the assault allegation, and will not be rehired, the company wrote.
The Orange County Sheriff’s Department has an ongoing investigation into the assault allegations, according to its chief spokeswoman, Carrie Braun. The investigation is under the department’s Special Victims Bureau, which handles sexual assault cases.
A sheriff report shows deputies were called to TREEhouse on Aug. 19 of last year and transported the alleged victim to what the report calls a “safe” location. She stated she was raped by a staff member, who she said “forced himself on her,” according to the report.
The accused staff member said he had never been alone with the alleged victim.
A forensic examination of the resident was conducted at the safe location, Braun said. She declined to release the findings, citing the ongoing investigation.
Telecare, county health officials, and the Sheriff’s Department declined to disclose the former employee’s name.
“He obviously was let go, and will never be rehired by the company,” said Olson, the Telecare spokesman.
County officials said Telecare followed the proper procedure for reporting the allegations.
“I think that Telecare was very responsive to the incident in every way. And they moved quickly to resolve [it] and to provide services to the client,” said Mugrditchian, the county behavioral health operations chief, in an interview.
The county asked Telecare what could have been done differently and if it was changing its hiring practices and monitoring of staff in response to the assault report. Telecare responded that it “will continue to follow” its internal policy for background screening, which includes a criminal background check, a search of a national sex offenders list, and checking the status of clinical licenses.
When Telecare was hiring the employee, the background check did not show any criminal history, Olson said.
While Telecare has said it will not re-hire the former employee, county officials said if he applied to a similar job at a different company, that company might not have a way of knowing about the allegations.
“There really isn’t a way to address human resources issues across providers,” said Mugrditchian.
“If an individual is licensed, and the actions are substantiated, the expectation would be that it would be reported to the state licensing board, if the individual was licensed and there was actual cause to be informed. But between providers there’s no way to share human resources issues, for confidentiality purposes.”
The employee accused of assault was not licensed, she said.
“I’m not aware of any systems” for future employers to learn of the allegations, other than a criminal background check that would show charges or convictions, Mugrditchian said. In this case, the investigation is ongoing a year after the allegations and a decision on charges has not yet been made.
Olson, the Telecare spokesman, said his understanding is there is a way for potential future employers to learn of the allegations, though he declined to describe how. “My understanding is yes, but I’ve been admonished not to get into a lot of details,” he said.
Nick Gerda covers county government and Santa Ana for Voice of OC. You can contact him at firstname.lastname@example.org.