secure.dss.ca.gov/ccld/TransparencyAPI/api/FacilityReports

Department of
SOCIAL SERVICES
Community Care Licensing

FACILITY EVALUATION REPORT
Facility Number: 602300055
Report Date: 10/29/2013
Date Signed 01/15/2016 10:44:55 AM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814

FACILITY NAME:

CLARINDA ACADEMY

FACILITY NUMBER:

602300055

ADMINISTRATOR:

MIKE BUTT

FACILITY TYPE:

731

ADDRESS:

TELEPHONE:

CITY:

STATE:

ZIP CODE:

CAPACITY:

242

CENSUS: 185

DATE:

10/29/2013

TYPE OF VISIT:

Case Management - Other

ANNOUNCED

TIME BEGAN:

10:24 AM

MET WITH:

Reggie St. Romain, Mike Butt, Andrea
Yerington

TIME COMPLETED:

02:55 PM

NARRATIVE

1/13

 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

PURPOSE OF VISIT:
As mandated by California law, this visit was performed on the date referenced by the undersigned
California Department of Social Services (CDSS) licensing evaluator for the purpose of annual
recertification. Annual recertification is performed in order to assure that the facility continues to:
have adequate and appropriate resources to provide safe, suitable 24-hour residential care,
supervision and treatment services to youth in care.
remain in substantial compliance with California licensing standards and regulations, as well
as licensing standards and laws of the state the facility is located - in this case, the state of
Iowa.
CERTIFICATION HISTORY; FACILITY INFORMATION AND PROGRAM :
Clarinda Academy has been certified by the CDSS since October 23, 2008.
Clarinda Academy is a 252-bed residential treatment and educational program for adjudicated and/or
at risk male and female youth, age 12 to 17. At the time of this year's visit, the facility census was
185. In addition to having youth from Iowa and California in residence, the facility has youth from
numerous other states.
The program offered emphasizes behavioral change through the establishment of a positive
peer/normative culture, intensely scheduled programming, and skill-building activities. Clarinda's
behavioral thinking processes focus on the intervention and redirection of negative behavior and
recognition of desired/positive behavior. (NOTE: Reference the initial certification report of October
23, 2008 for a complete description and overview of Clarinda, its program, purpose, methods and
goals. )

SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE
SIGNATURE:

DATE: 12/12/2013

This report must be available at Child Care and Group Home facilities for public review for 3
years.
LIC809 (FAS) - (06/04)

Page: 1 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814
2/13

 FACILITY NAME: CLARINDA
ACADEMY

FACILITY NUMBER: 602300055
VISIT DATE: 10/29/2013

NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

CA PLACING AGENCIES:
There are currently 41 probation wards and social services dependents from California placed at the
facility. California placing agencies include the following in the number indicated:
Alameda County Probation (6)
Imperial County Probation (2)
Imperial County Social Services (1)
Kern County Probation (4)
Marin County Probation (1)
Riverside County Probation (5)
Sacramento County Probation (8)
Sacramento County Social Services (1)
San Joaquin County Probation (5)
San Joaquin County Social Services (1)
Santa Clara County Probation (2)
Sonoma County Social Services (4)
Stanislaus County Probation (1)
IOWA LICENSING INFORMATION
As part of this certification review, contact with Iowa Licensing and copies of current licenses and
licensing reports were collected. Each residential building (known as a hall) on the Clarinda campus is
licensed individually as a Community Residential facility by the Iowa Department of Human Services.
The name of each hall, their capacity and the effective dates of the current licenses are as follows:
Washington Hall (Capacity 30): 9/1/2013 through 9/1/2014
Jackson Hall (Capacity 32): 5/1/2013 through 5/1/2014.
Kennedy Hall (Capacity 31): 5/1/2013 through 5/1/2016
Jefferson Hall (Capacity 30): 5/1/2013 through 5/1/2016

SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

3/13

 FACILITY REPRESENTATIVE
SIGNATURE:

LIC809 (FAS) - (06/04)

DATE: 12/10/2013

Page: 2 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CLARINDA
ACADEMY

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814

FACILITY NUMBER: 602300055
VISIT DATE: 10/29/2013

NARRATIVE

4/13

 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

IOWA LICENSING INFORMATION (Continued)
Lincoln Hall (Capacity 33): 1/1/2012 through 1/1/2015
Coolidge Hall (Capacity 26): 11/1/2011 11/1/2014
Angelou Hall (Capacity 32): 11/1/2011 through 11/1/2014
Parks Hall (Capacity 28): 11/1/2011 through 11/1/2014
Anthony Hall (Capacity 10): 1/1/2013 through 1/1/2016
Regan Hall (Capacity 15): 7/1/2013 through 7/1/2016
COMPLAINTS AND INVESTIGATIONS:
No formal complaints concerning Clarinda were made to the CDSS during this certification period.
Iowa Licensing and local law enforcement conducted numerous visits and investigations over the last
year; however, the facility remains in good standing with Iowa Licensing. (Note: This summary is not
all inclusive and does not include child abuse allegations or licensing violations determined to be
unfounded and/or unsupported or any investigations in progress.)
On or about October 15, 2012, a resident's collarbone was broken during a restraint.
Investigation revealed that the staff who performed the restraint utilized an unapproved
physical restraint technique. This staff, as well as two others who were witnesses, also
participated in a "cover up" of any wrongdoing. Staff involved were immediately placed on
administrative suspension pending the outcome of an internal investigation. Internal
investigation findings resulted in two of the three staff being terminated. The third staff who
played a lesser role, received severe disciplinary action but was not terminated.
During an unannounced visit on June 5, 2013 by Iowa Licensing, the facility was cited for
some employee record deficiencies (inadequate information relative to documentation of
work performance evaluations); and for a staff training related violation (one or more
employees not being properly trained in child abuse identification and training.)
A physical restraint occurring June 24, 2013 resulted in a multi-tiered investigation into
allegations of assault and/or abuse by a staff member. This investigation occurred after the
youth who was the subject of a restraint passed out the following day due to possible head
trauma incurred and required emergency hospitalization. Law enforcement opined that an
assault did not occur; however, the staff who performed the restraint was placed on the Iowa
Central Abuse Registry by Iowa CPS for "founded" physical abuse.

SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE
SIGNATURE:

LIC809 (FAS) - (06/04)

DATE: 12/10/2013

Page: 3 of 8

5/13

 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CLARINDA
ACADEMY

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814

FACILITY NUMBER: 602300055
VISIT DATE: 10/29/2013

NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

COMPLAINTS AND INVESTIGATIONS: (Continued)
In a restraint on July 12, 2013, the youth being restrained was resistive and hit the Clarinda
staff trying to restrain him. In reaction, the staff hit lost his temper and struck the youth three
times with his fist. Neither party suffered visible injury and neither wished to press charges.
The staff was remorseful afterwards and forthwith in admitting his reaction was wrong. The
staff was nevertheless terminated. No licensing violations cited.
In September 2013, Iowa Licensing conducted an investigation and cited deficiencies related
to a runaway incident occurring September 5, 2013. In that incident, one client attempted to
escape from the window of her third floor dorm room using bed sheets tied together.
However, once outside her window, she fell all the way to the ground seriously injuring herself.
During the commotion, another youth who was conspiring with her successfully eloped by
running out of the unit. Deficiencies cited were related to staff hearing rumors the day before
of the runaway plan and failing to share this information with any other facility staff.
FACILITY, PHYSICAL PLAN AND PROGRAM CHANGES:
No significant changes.
FIRE INSPECTION / FOOD SERVICE:
It should be noted that Clarinda Academy's buildings and grounds is leased space located within the
Clarinda Treatment Complex owned by the State of Iowa. Much of the maintenance as well as the
food service is provided by Complex employed staff.
Clarinda was last inspected and certified to meet fire safety rules, regulations and standards by an
official with the Iowa Department of Public Safety, Fire Marshall's Division on May 30, 2013.
Meal preparation and service is conducted out of a main, full service (commercial style)
kitchen/cafeteria located on the Clarinda Treatment Complex grounds. The kitchen and cafeteria is
owned and operated by the State of Iowa. Other entities on the complex grounds utilize the kitchen
as well, however, meal times are staggered and there is no commingling of clients. The kitchen was
last inspected by authorities with Western Iowa Regional Inspections on May 13,, 2013. A walk
through of the kitchen by this analyst revealed no issues of concern.

6/13

 SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE
SIGNATURE:

LIC809 (FAS) - (06/04)

DATE: 12/10/2013

Page: 4 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CLARINDA
ACADEMY

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814

FACILITY NUMBER: 602300055
VISIT DATE: 10/29/2013

NARRATIVE

7/13

 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

ACCREDITATIONS:
Clarinda Academy clients attend an on-grounds private school (7th thru 12 grade) accredited by the
North Central Association Commission on Accreditation and School Improvement, a division of
AdvancED. The current accreditation is good through July 30, 2018.
Clarinda Academy is accredited by the Joint Commission which has surveyed the organization and
found it to meet the requirements for the Behavioral Health Care Accreditation Program.
Accreditation was issued on February 19, 2011 and is valid for up to 36 months.
Clarinda Academy is also certified by the Iowa Department of Public Health as meeting the
requirements to conduct and maintain Juvenile Level I and II.1 Substance Abuse Treatment Services.
(Effective June 12, 2011 through February 19, 2014.)
SCOPE AND STATUS OF RECERTIFICATION REVIEW:
Entrance interview with Executive Director Reggie St Romain; Group Living Director Mike Butt
and Andrea Yerington, Quality Assurance Officer.
Collection of updated and current licensing documents, organizational and program
information material.
Discussion on the implementation of CA AB 12 (Fostering Connections to Success Act.)
Sample of client files reviewed.
Sample of personnel files reviewed.
Walking tour of campus and all living halls
Four clients interviewed
FINDINGS, CONCERNS, VIOLATIONS:
Facility found to be clean, safe, sanitary and in good repair. Services provided meet or exceed CA
group home licensing standards.

SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE
SIGNATURE:

LIC809 (FAS) - (06/04)

DATE: 12/10/2013

Page: 5 of 8

8/13

 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CLARINDA
ACADEMY

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814

FACILITY NUMBER: 602300055
VISIT DATE: 10/29/2013

NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

FINDINGS, CONCERNS, VIOLATIONS (Continued)
The following are areas that need to be brought into compliance with California Title 22 group home
licensing standards:
Monthly Restraint Log [Section 84361(f) & (g)]
A monthly log of each use of manual restraints must be maintained by the facility and available for
review and/or production to the CDSS upon request during normal business hours.
Note: Restraints include all escorts and re-directions where there is any element of force used or the
client's free movement is infringed upon.)
The log must be available for review and/or production to the CDSS upon request and each incident
of manual restraint needs to include the following:
Name (or initials) of each child and identification of placing state/entity.
Date and time of the intervention.
Duration of the intervention.
Identification of the SCM physical hold or restraint technique used.
Name(s) of facility staff member(s) who participated in the physical intervention.
Result, comments or evidence of administrative review.
Internal Biannual Review of the Use of Emergency (Physical) Interventions
Procedures for an internal biannual review of the use of emergency interventions must be developed.
Procedures must include at least the following:
(1) Review to be conducted by the administrator or the administrator's designee.
(2) Analysis of patterns/trends of use of emergency interventions in the previous six (6) month
period, based on:
a) Review of all records related to the use of emergency interventions for accuracy and
completeness.
b) Review of the use, effectiveness and duration of each emergency intervention including, a
determination of the effectiveness and appropriateness of the intervention technique used in
each situation.
c) Review of the frequency of emergency interventions in the previous six (6) month period.

9/13

 SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE
SIGNATURE:

LIC809 (FAS) - (06/04)

DATE: 12/10/2013

Page: 6 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CLARINDA
ACADEMY

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814

FACILITY NUMBER: 602300055
VISIT DATE: 10/29/2013

NARRATIVE

10/13

 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

FINDINGS, CONCERNS, VIOLATIONS (Continued)
(3) Corrective or improvement action plan, if needed.
(4) *The biannual review and corrective or improvement action plan must be submitted to the
Department no later than the fifth (5th) day of the month following the review.
(5)The licensee shall provide a copy of the biannual review and corrective action plan, if applicable, to
the authorized representative upon request.
Biannual review reports to be provided to CDSS beginning July 5, 2014 (for period January 1 through
June 30, 2014) and January 1, 2015 (for period July 1, 2014 through December 31, 2014) and for
every six month period thereafter.
AB 12 / Non-Minor Dependent Program Addendum
Currently, Clarinda's CDSS certification allows for the facility to care for male and female youth ages
11 to 17.
On January 1, 2012, new interim California licensing regulations went into effect as a result of the
passage of California Assembly Bill (AB) 12 passed in 2011.
Formerly, foster care benefits and services virtually ended when a child turned 18. In short, AB 12
extends benefits in a variety and number of ways to youth who have "aged out." Such youth (termed
non-minor dependents or NMDs for short) may now remain in group home care until they complete
high school or its equivalent (up to age 19 maximum.) However, in order to continue to provide care
for them, the facility must comply with new AB 12 regulations.
In July of 2012, CCLD Information Release 2013-02 was mailed to all out-of-state group home
providers explaining the new law and instructing that if a group home facility was desirous of
retaining and providing services to NMDs a program statement addendum was in order.
Although Clarinda Academy did provide a letter to the CDSS indicating it was their intention to retain
18 year olds in their care until high school completion of its equivalent, they have not submitted an
AB 12 program statement addendum. Until the facility submits an AB 12 program addendum, CDSS
approval to provide care to NMDs will not be given.

SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2013

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE
SIGNATURE:

LIC809 (FAS) - (06/04)

DATE: 12/10/2013

Page: 7 of 8

11/13

 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES
AGENCY
FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CLARINDA
ACADEMY

CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS
8-3-54
SACRAMENTO, CA 95814

FACILITY NUMBER: 602300055
VISIT DATE: 10/29/2013

NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

PLAN OF IMPROVEMENT OR CORRECTION:
A written plan addressing the aforementioned three areas (Monthly Restraint Log; Biannual Review of
Emergency Interventions; AB 12 Program Statement addendum) is expected to be submitted to the
CDSS by December 31, 2013.
CERTIFICATION DECISION:
Re-certify.
Recertification may be revisited if the facility fails to properly address the items referenced in the plan
of correction above in a timely manner.

SUPERVISOR'S NAME: Mei Yuk Kung

TELEPHONE: (916) 3278763

LICENSING EVALUATOR NAME: Carol Lancaster

TELEPHONE: (916) 8385751

LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2013

12/13

 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE
SIGNATURE:

LIC809 (FAS) - (06/04)

DATE: 12/12/2013

Page: 8 of 8

13/13