Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
R 0000 Opening Comments.
The purpose of this visit on September 1, 2010 was to investigate 86273. A subsequent visit was
conducted on September 9, 2010.
R 0801 290-2-5-.08(2) Administration and Organization.
SS=D
Program Description and Implementation. In accordance with these rules and regulations, a licensed child caring
institution shall develop, implement and comply with written policies and procedures that describe the range of
services including room, board
This Requirement is not met as evidenced by:
Bases on record review and staff interview, the agency failed to develop and comply with policies
and procedures as to how services will be provided by the facility;
Findings Include:
(1) Record review on September 1, 2010 of the agency's Medication Administration Policy
indicated that when dispensing medication, the staff member will follow standard protocol in the
distribution of medication:
{ asking the child his/her name
{ the medication box
{ MAR (medication administration record) to identify the prescribed medication and student
photo to make sure the correct student is receiving the correct medication
{ will ask the student to identify the medication she/he is seeking
{ will be placed in a cup and staff will check the child ' s mouth to verify that the medication is
swallowed
{ will sign a signature sheet to record the administration of the medication, and
{ will sign the MAR.
In addition in case of medication errors and/or the administration of the wrong medication or
wrong dosage ingested the Department (Office of Residential Child Care) will be notified.
(2 ) Record review on September 1, 2010 of Incident Report dated 08-27-10 for Resident #15
revealed that on 08-27-10, Staff C inadvertently administered the medications of another child to
Page 1 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
Resident #15. In addition review of Incident Report dated 06-05-10 for Resident #5 revealed
Resident #5 was inadvertently given the wrong medication after a group of residents crowded the
dispensary area and staff failed to properly follow medication administration procedure. The
incidents were never reported to the Office of Residential Child Care.
(3) During an interview on September 9, 2010 at about 3:03 PM with Staff DD, Staff DD
acknowledged that the resident's parents are notified regarding incidents involving the child.
Staff DD further indicated that the agency take medication errors very seriously and
acknowledged that it is considered a serious incident. Staff DD acknowledged that the incidents
were not reported within the 24 hour time frame as required by the Department. Staff DD further
indicated that the agency was unclear if several of the incidents in question were reportable
incident.
R 0833 290-2-5-.08(5)(d)4. Recordkeeping. Personnel Records.
SS=B
[Written personnel records] records shall include the following: ...
4. Documentation of at least two professional, educational, or personal references that attest to the person's
capabilities of performing the duties for which they are employed and to t
This Requirement is not met as evidenced by:
Based on a review of personnel files and staff interview, the agency failed to document at least
two professional, educational, or personal references that attest to the person's capabilities of
performing the duties for which they are employed and to the person's suitability of working with
or around children in four of ten files reviewed;
Findings Include:
(1) Record review on September 9, 2010 of Staff C, E, and F's file revealed that agency failed to
maintain documentation of at least two references. In addition, review of Staff H's file revealed
Page 2 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
the agency documented only one reference.
(2) During an interview on September 9, 2010 at about 2:15 pm with Staff EE, Staff EE indicated
that she/he is responsible for completing and maintaining employee personnel files. Staff EE
monitors the files for compliance when time permits to ensure that files are updated; however
Staff EE indicated that she/he was not fully aware of all requirements in maintaining personnel
files other than what is indicated by the agency wide checklist of the required documents needed
in the personnel files.
(3) During an interview on September 9, 2010 at about 2:35 pm with Staff DD, Staff DD indicated
that agency protocol is that staff members are required to provide references within 90 days of
employment.
This tag was previously cited on 12-03-08.
R 0834 290-2-5-.08(5)(d)5. Recordkeeping. Personnel Records.
SS=D
[Written personnel records] records shall include the following: ...
5. Satisfactory preliminary criminal history background check determination and a satisfactory fingerprint records
check determination as required by law for the director and foster par
This Requirement is not met as evidenced by:
Based on a review of resident files and e-mail correspondence with staff, the facility failed to
document a satisfactory preliminary criminal history background check on adults aged eighteen
or older who reside at the home;
Page 3 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
Findings Include:
(1) Review of the record of eighteen year-old Resident #1 on September 9, 2010 revealed that the
agency failed to obtain a criminal background check.
(2) E-mail correspondence with Staff DD on 09/16/2010 at 8:32 am revealed that there were 23
other residents who lived or had lived at the facility since January 1, 2010. Staff DD
acknowledged that criminal background checks had not been obtained on any of these residents.
R 0838 290-2-5-.08(5)(d)9. Recordkeeping. Personnel Records.
SS=D
[Written personnel records] records shall include the following: ...
9. Documentation of orientation and training, including dates of all such training, as required by Rule .08(6)(d) of
these rules; ...
This Requirement is not met as evidenced by:
Based on review of personnel files and staff interview, the agency failed to document orientation
and training in eight of ten files reviewed;
Findings Include:
(1) Record review on September 9, 2010 of Staff A, B, C, D, E, F, H, and J's file revealed that there
was no documentation to support that orientation and training had been provided to each staff
member.
(2) During an interview on September 9, 2010 at about 2:15 pm with Staff EE, Staff EE indicated
that she/he is responsible for completing and maintaining employee personnel files. Staff EE
monitors the files for compliance when time permits to ensure that files are updated; however
Staff EE indicated that she/he was not fully aware of all requirements in maintaining personnel
files other than what is indicated by the agency wide checklist of the required documents needed
in the personnel files.
Page 4 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
(3) During an interview on September 9, 2010 at about 2:35 pm with Staff DD, Staff DD indicated
that initial orientation and training is provided by him/herself regarding the policies and
procedures related to the organization and job however the department heads provided training
specific to the role of the particular staff member. Staff DD indicated that all staff received
orientation and training however the agency was unable to provide documentation of the staff
members' receipt of the training.
R 0840 290-2-5-.08(6) Staffing.
SS=E
Staffing. The institution shall have sufficient numbers of qualified and trained staff as required by these rules to
provide for the needs, care, protection, and supervision of children. All staff and volunteers shall be supervised to
ensure that assigne
This Requirement is not met as evidenced by:
Based on record review, resident and staff interviews, the agency failed to provide for the needs,
care, protection, and supervision of the children in care;
Findings Include:
(1) During an interviews conducted on September 1, 2010 from 1:00 pm-3:30 pm with Residents
101, 102, 108, 109, 110, and 112 in which all residents acknowledged that they are aware of
residents engaging in sexually inappropriate behavior. It was reported that the residents would
sneak off in designated areas unbeknownst to staff.
(2) Record review on September 1, 2010 of Incident Report dated 06-06-10 for Resident #11
revealed Resident #11 along with 6 other females disclosed to staff an incident involving sexual
activity between Resident #11 and an older male resident. It was documented that Resident #11
appeared upset and stated that what occurred between herself (R11) and the male resident was
Page 5 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
an unwelcome encounter. Furthermore, it was documented that Resident #11 initially lied about
the incident because she/he did not want the peer to get in trouble. In addition, review of Incident
Report dated 04-25-10 for Resident #11 revealed that Resident #11 was found around 8:15 am
asleep in the bed with Resident #15. Furthermore, review of Incident Report dated 05-08-10 for
Resident #15 revealed that a room search was conducted in which several notes were found
referencing several sexual encounters with male students.
(3) During an interview on September 9, 2010 at about 12:43 pm with Staff AA, Staff AA indicated
that to his/her knowledge there has been no current sexual activity reported and/or observed
amongst the students however Staff AA acknowledged that previously there was an issue in
which Resident #11 made allegations against a male student. After a week of the incident
Resident #11. Resident #11 child reported the story in which the story changed when she spoke
with another counselor and her mother. In regards to the incidents with Resident #15 it was
found that Resident #15 had engaged in sexual acting out on 3 separate occasions in some sort
of consensual encounter with another male student in which Resident #15 reported that she/he
engaged in sexual inappropriate activities with the male peer in which the incident incident
occurred in the music room at student activity center and the other two incidents occurred in the
movie room in student activity center and the bathroom in academic building. The agency
conducted an investigation which revealed that the incidents occurred and all parents of the
residents were notified.
(4) During an interview on September 9, 2010 at about 5:00 pm with Staff DD, Staff DD indicated
that the clinical director followed up with the counselor regarding the allegations in which
Resident #11 re-canted the allegation. As a result of the incident she/he re-wrote the abuse
reporting policy and procedure effective April 2010 which addressed the reporting of allegations
as a means to address reporting of incidents and it addressed specific procedures in which the
counselors to follow in reporting of incidents.
This rule was previously cited on 07-21-10.
Page 6 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
R 0852 290-2-5-.08(6)(d)1. Staffing.
SS=E
[Staff] orientation shall include instruction in:
(i) The institution's purpose and description of services and its policies and procedures;
(ii) The employee's assigned duties and responsibilities;
(iii) Grievance policies and procedures;
(iv) Child
This Requirement is not met as evidenced by:
Based on review of personnel files and staff interview, the agency failed to document all required
components of orientation training needed prior to the staff being able to work with the residents
in eight of ten files reviewed;
Findings Include:
(1) Record review on September 9, 2010 of Staff A, B, C, D, E, F, H, and J's file revealed that there
was no documentation to support that orientation and training had been provided to each staff
member.
(2) During an interview on September 9, 2010 at about 2:15 pm with Staff EE, Staff EE indicated
that she/he is responsible for completing and maintaining employee personnel files. Staff EE
monitors the files for compliance when time permits to ensure that files are updated; however
Staff EE indicated that she/he was not fully aware of all requirements in maintaining personnel
files other than what is indicated by the agency wide checklist of the required documents needed
in the personnel files.
(3) During an interview on September 9, 2010 at about 2:35 pm with Staff DD, Staff DD indicated
that initial orientation and training is provided by him/herself regarding the policies and
procedures related to the organization and job however the department heads provided training
specific to the role of the particular staff member. Staff DD indicated that all staff received
orientation and training however the agency was unable to provide documentation of the staff
Page 7 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
members' receipt of the training.
This tag was previously cited on 12-03-08.
R 0861 290-2-5-.08(7) Staffing.
SS=D
Reporting. Detailed written summary reports shall be made to the Department of Human Resources, Office of
Regulatory Services, Residential Child Care Unit via email or fax on the required incident intake information form
(IIIF) within 24 hours.
This Requirement is not met as evidenced by:
Based on record review and staff interview, the agency failed to submit a detailed written
summary report to the Department of Human Services, Office of Residential Child Care (ORCC)
via e-mail or fax on the required incident intake information form (IIIF) within 24 hours in ten of
thirty-five incidents reviewed;
Findings Include:
(1) Record review on September 1, 2010 of Incident Report dated 08-04-10 for Resident #16
revealed that on 08-04-10, Resident #16 was taken to the emergency room for a nondisplaced
fracture of the Right 5th metacarpal head (right hand).
(2) Record review on September 1, 2010 of Incident Report dated 08-27-10 for Resident #15
revealed that on 08-27-10, Staff C inadvertently administered to Resident #15 the medication
Citolopram that was intended for another child.
Page 8 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
(3) Record review on September 1, 2010 of Incident Report dated 06-06-10 for Resident #11
revealed Resident #11 along with 6 other females disclosed to staff an incident involving sexual
activity between Resident #11 and an older male resident. It was documented that Resident #11
appeared upset and stated that what occurred between herself (R11) and the male resident was
an unwelcome encounter. Furthermore, it was documented that Resident #11 initially lied about
the incident because she/he did not want the peer to get in trouble.
(4) Record review on September 1, 2010 of Incident Report dated 12-04-09 for Resident #17
revealed Resident #17 was involved in an altercation with a peer while staff was in process of
restraining another peer. It was documented that staff intervened after hearing Resident #17
screaming and proceeded to restrain the peer. Resident #17 ran out the dorm and the police was
notified of the elopement. Later Resident #17 was found by the pond in which she/he threatened
to throw his/herself in the pond in which Resident #17 eventually did and staff retrieved Resident
#17 out the water. The ambulance was called to assess Resident #17 for hypothermia. In addition,
review of Incident Report dated 05-08-10 for Resident #17 revealed that a room search was
conducted in which several notes were found referencing sexual contact with male peers at the
facility.
(5) Record review on September 1, 2010 of Incident Report dated 06-05-10 for Resident #5
revealed Resident #5 was inadvertently given the wrong medication after a group of residents
crowded the dispensary area and staff failed to properly follow medication administration
procedure. In addition, review of Incident Report dated 05-13-10 for Resident #5 revealed
Resident #5 was treated and cleared by Lumpkin Co Paramedics for seizure disorder in which
resident lost consciousness for about 4 minutes.
(6) Record review on September 1, 2010 of Incident Report dated 07-20-10 for Resident #2
revealed that a missing person was filed with Lumpkin Co Police for Resident #2 after a room
check was conducted around 9:20 pm in which Resident #2 was observed missing from the
facility. In addition, review of Incident Report dated 07-15-10 revealed Resident #2 gave his/her
psychotropic medication, Seroquel, to another peer. Furthermore, review of Incident Report
dated 07-02-10 revealed Resident #2 tested positive for THC which she/he brought on campus on
06-30-10.
(7) Record review on September 1, 2010 of Incident Report dated 05-13-10 for Resident #3
revealed Resident #3 was transported to the hospital for possible concussion after Resident #3
reported hitting his/her head on a rock resulting in nausea and dizziness. All of the incidents
documented were not reported to the Department (ORCC) as of September 1, 2010.
Page 9 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
(
During an interview on September 9, 2010 at about 3:03 PM with Staff DD, Staff DD
acknowledged that the resident's parents are notified regarding incidents involving the child.
Staff DD further indicated that the agency take medication errors very seriously and
acknowledged that it is considered a serious incident. Staff DD acknowledged that the incidents
were not reported within the 24 hour time frame as required by the Department. Staff DD further
indicated that the agency was unclear if several of the incidents in question were reportable
incident.
R 0862 290-2-5-.08(7)(a-g) Staffing.
SS=D
This [detailed written summary] report shall be made regarding serious occurrences involving children in care,
including but not limited to:
(a) Accidents or injuries requiring medical treatment and/or hospitalization;
(b) Death;
(c) Suicide attempts;
(
This Requirement is not met as evidenced by:
Based on record review and staff interview, the agency failed to report incidents regarding
serious occurrences involving children in care in ten of thirty-five incidents reviewed;
Findings Include:
(1) Record review on September 1, 2010 of Incident Report dated 08-04-10 for Resident #16
revealed that on 08-04-10, Resident #16 was taken to the emergency room for a nondisplaced
fracture of the Right 5th metacarpal head (right hand).
(2) Record review on September 1, 2010 of Incident Report dated 08-27-10 for Resident #15
Page 10 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
revealed that on 08-27-10, Staff C inadvertently administered to Resident #15 the medication
Citolopram that was intended for another child.
(3) Record review on September 1, 2010 of Incident Report dated 06-06-10 for Resident #11
revealed Resident #11 along with 6 other females disclosed to staff an incident involving sexual
activity between Resident #11 and an older male resident. It was documented that Resident #11
appeared upset and stated that what occurred between herself (R11) and the male resident was
an unwelcome encounter. Furthermore, it was documented that Resident #11 initially lied about
the incident because she/he did not want the peer to get in trouble.
(4) Record review on September 1, 2010 of Incident Report dated 12-04-09 for Resident #17
revealed Resident #17 was involved in an altercation with a peer while staff was in process of
restraining another peer. It was documented that staff intervened after hearing Resident #17
screaming and proceeded to restrain the peer. Resident #17 ran out the dorm and the police was
notified of the elopement. Later Resident #17 was found by the pond in which she/he threatened
to throw his/herself in the pond in which Resident #17 eventually did and staff retrieved Resident
#17 out the water. The ambulance was called to assess Resident #17 for hypothermia. In addition,
review of Incident Report dated 05-08-10 for Resident #17 revealed that a room search was
conducted in which several notes were found referencing sexual contact with male peers at the
facility.
(5) Record review on September 1, 2010 of Incident Report dated 06-05-10 for Resident #5
revealed Resident #5 was inadvertently given the wrong medication after a group of residents
crowded the dispensary area and staff failed to properly follow medication administration
procedure. In addition, review of Incident Report dated 05-13-10 for Resident #5 revealed
Resident #5 was treated and cleared by Lumpkin Co Paramedics for seizure disorder in which
resident lost consciousness for about 4 minutes.
(6) Record review on September 1, 2010 of Incident Report dated 07-20-10 for Resident #2
revealed that a missing person was filed with Lumpkin Co Police for Resident #2 after a room
check was conducted around 9:20 pm in which Resident #2 was observed missing from the
facility. In addition, review of Incident Report dated 07-15-10 revealed Resident #2 gave his/her
psychotropic medication, Seroquel, to another peer. Furthermore, review of Incident Report
dated 07-02-10 revealed Resident #2 tested positive for THC which she/he brought on campus on
06-30-10.
(7) Record review on September 1, 2010 of Incident Report dated 05-13-10 for Resident #3
Page 11 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
revealed Resident #3 was transported to the hospital for possible concussion after Resident #3
reported hitting his/her head on a rock resulting in nausea and dizziness. All of the incidents
documented were not reported to the Department (ORCC) as of September 1, 2010.
(
During an interview on September 9, 2010 at about 3:03 PM with Staff DD, Staff DD
acknowledged that the resident's parents are notified regarding incidents involving the child.
Staff DD further indicated that the agency take medication errors very seriously and
acknowledged that it is considered a serious incident. Staff DD acknowledged that the incidents
were not reported within the 24 hour time frame as required by the Department. Staff DD further
indicated that the agency was unclear if several of the incidents in question were reportable
incident.
R 1003 290-2-5-.10(b) Assessment and Planning.
SS=C
A service and room, board and watchful oversight plan shall be developed by the child's Human Services
Professional in concert with the child's primary Child Care Worker, meaning the worker who has responsibility for
supervision of the child in the living
This Requirement is not met as evidenced by:
Based on review of resident files and staff interview, the agency failed to develop a complete
service and room, board and watchful oversight (SRBWO) plan in four of five files reviewed;
Findings Include:
Page 12 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
(1) Record review on September 1, 2010 of Resident #2's SRBWO or Individual Service Plan (ISP)
(dated 08/10), Resident #4's SRBWO/ISP (dated 05/10), Resident #11's SRBWO/ISP (04/10), and
Resident #15's SRBWO/ISP (dated 01/10) revealed that agency failed to address
objectives/activities utilized by staff to assist the residents in attaining their stated goals,
preliminary plans of discharge, and any special care and/or services in the Individual Service
Plans for the residents. .
(2) According to e-mail correspondence dated September 23, 2010 from Staff DD, Staff DD
indicated that the agency ensures that the Individual Service Plans maintain the required
components for an SRBWO as indicated by the Departments rules and regulations.
This rule was previously cited on 07-21-10, 12-10-09 and 12-03-08.
R 1209 290-2-5-.12(3)(a)1.(i) Health Services.
SS=C
Such [general physical] examination shall be done by a medical doctor, physician's assistant, or public health
department and shall include basic diagnostic laboratory work, including but not limited to a Complete Blood Count
(CBC) and basic urinanalysis;
This Requirement is not met as evidenced by:
Based on review of resident files and staff interview, the agency failed to document a Complete
Blood Count (CBC) in five of fourteen files reviewed. In addition, the agency failed to document
that a basic urinanalysis (UA) was included in the physical examination in twelve of fourteen files
reviewed;
Findings Include:
(1) On September 1, 2010, a review of the records for Resident #1 admitted 01/2010, Resident #2
Page 13 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
admitted 06/2010, Resident #3 admitted 03/2010, Resident #8 admitted 09/2009, Resident #9
admitted 03/2010, Resident #11 admitted 04/2010, Resident #12 admitted 04/2010, and Resident
#13 admitted 01/2010, revealed that there was no documentation of a complete blood count
within one year previous to or 72 hours after admission to the facility.
(2) On September 1, 2010, a review of the records for Resident #1 admitted 01/2010, Resident #2
admitted 06/2010, Resident #3 admitted 03/2010, Resident #4 admitted 05/2010, Resident #5
admitted 02/2010, Resident #6 admitted 08/2010, Resident #7 admitted 03/2010, Resident #8
admitted 08/2010, Resident #9 admitted 04/2010, Resident #11 admitted 04/2010, Resident #12
admitted 04/2010, and Resident #14 admitted 01/2010 revealed that there was no documentation
of a urinalysis within one year previous to or 72 hours after admission to the facility.
(2) In an e-mail sent Thursday, September 30, 2010 4:25 PM, Staff DD was given the opportunity
to respond to this finding. In response Staff DD sent an e-mail on October 1, 2010 at 1:39 PM in
which Staff DD did not dispute the findings in this correspondence. However, Staff DD provided
further documentation of physical examinations provided for students after September 1, 2010.
This rule was previously cited on 12-10-09 and 12-03-08.
R 1211 290-2-5-.12(3)(a)2. Health Services.
SS=B
A general dental examination of the child shall be provided for unless such an examination has been completed
within six months prior to admission. Such examinations shall be done by either a dentist or a dental hygienist that
is employed by the departmen
Page 14 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
This Requirement is not met as evidenced by:
Based on review of resident files and staff interview, the facility failed to document a dental exam
dated less than six months prior to admission or within thirty days after admission in four of
fourteen files reviewed;
Findings include:
On September 1, 2010, a review of the files for Resident #8 admitted 08/2010, Resident #10
admitted 07/2010, Resident #11 admitted 04/2010, Resident #12 admitted 04/2010, and Child #14
admitted 01/2010 revealed that there was no evidence of a dental examination within six months
prior to or thirty days after admission to the facility.
In an email sent Thursday, September 30, 2010 4:25 PM, Staff A was given the opportunity to
respond to this finding. In response Staff A sent an email on October 1, 2010 at 1:39 PM, Staff A
did not dispute the findings in this correspondence. However, Staff A provided further
documentation of physical examinations provided to students after September 1, 2010.
This rule was previously cited on 12/10/2009
R 1217 290-2-5-.12(3)(d)2.i. Health Services.
SS=D
[Medication use and management] policies and procedures shall include the following: ...
2.(i) Prescription medications shall only be given to a child as ordered in the child's prescription. An institution shall
not permit such medications prescribed for
This Requirement is not met as evidenced by:
Based on record review and staff interviews, the agency failed to ensure that prescribed
medications for one child shall not be given to another child.
Page 15 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
Findings Include:
(1) Record review on September 1, 2010 agency Medication Administration Policy indicated that
when dispensing medication, the staff member will follow standard protocol in the distribution of
medication which includes asking the child his/her name, retrieve the med box, check MAR
(medication administration record) to identify the prescribed medication and student photo to
make sure the correct student is receiving the correct medication, the employee will ask the
student to identify the medication she/he is seeking, med will be placed in a cup and staff will
check the child ' s mouth to verify that the medication is swallowed, child will sign a sign sheet
to record the administration of the medication, and staff will sign the MAR. In addition in case of
medication errors and/or the administration of the wrong medication or wrong dosage ingested
the Department (Office of Residential Child Care) will be notified.
(2) On September 1, 2010, a review of the agency's incident report dated August 27, 2010 revealed
that Staff C inadvertently administered to Child #15 the medication Citolopram that was intended
for administration to another child. Citolopram was not prescribed for Child #15 by an authorized
by a health care professional.
(3) During an interview on September 9, 2010 at about 12:00 PM with Staff BB, Staff BB
acknowleged findings.
R 1219 290-2-5-.12(3)(d)3. Health Services.
SS=D
[Medication use and management] policies and procedures shall include the following: ...
3. Psychotropic medications. No child shall be given psychotropic medications unless use is in accordance with
the goals and objectives of the child's service plan. .
Page 16 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
This Requirement is not met as evidenced by:
Based on record review and interviews with staff, the facility failed to administer residents'
psychotropic medications in accordance with the goals and objectives of the child's service plan
in one of one incidents reviewed.
Findings:
(1) On September 1, 2010, a review of the agency's incident report dated August 27, 2010 revealed
that Staff C inadvertently administered to Child #15 the medication Citolopram that was intended
for administration to another child. A review of Resident #15's Individual Service Plan dated
August 2, 2010 at 9:37 AM revealed Resident #15's current medication was: Wellbutrin 150mg.
No other medications were listed on the individual service plan. The medication inadvertently
administered to Resident #15, Citolopram, is used to treat depression.
(2) During an interview on September 9, 2010 at about 12:00 PM with Staff BB, Staff BB
acknowleged findings.
When citing this tag one of the findings must include the RBWO plan and how it was
incorporated in the plan
R 1220 290-2-5-.12(3)(d)3.i. Health Services.
SS=D
[Medication use and management] policies and procedures shall include the following: ...
3.(i) Psychotropic medications must be prescribed by a physician who has responsibility for the diagnosis and
treatment of the child's conditions that necessitate suc
This Requirement is not met as evidenced by:
Based on record review and interviews with staff the facility failed to ensure that psychotropic
Page 17 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
medications must be prescribed by a physician who has responsibility for the diagnosis and
treatment of the child's conditions that necessitate such medication in one of one incidents
reviewed.
Findings:
(1) On September 1, 2010, a review of the agency's incident report dated August 27, 2010 revealed
that Staff C inadvertently administered to Child #15 the medication Citolopram that was intended
for administration to another child. The medication inadvertently administered to Child #15,
Citolopram, is used to treat depression.
(2) During an interview on September 9, 2010 at about 12:00 PM with Staff BB, Staff BB
acknowleged findings.
R 1221 290-2-5-.12(3)(d)3.ii. Health Services.
SS=D
[Medication use and management] policies and procedures shall include the following: ...
(ii) Psychotropic medication shall only be given to a child as ordered in the child's prescription. An institution shall
not permit such medications prescribed for on
This Requirement is not met as evidenced by:
Based on record review, review of agency medication policy and staff interviews, the agency
failed to ensure medication was given to a child as ordered by the physician in one of one file
reviewed;
Findings:
Page 18 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
(1) Record review on September 1, 2010 agency Medication Administration Policy indicated that
when dispensing medication, the staff member will follow standard protocol in the distribution of
medication which includes asking the child his/her name, retrieve the med box, check MAR
(medication administration record) to identify the prescribed medication and student photo to
make sure the correct student is receiving the correct medication, the employee will ask the
student to identify the medication she/he is seeking, med will be placed in a cup and staff will
check the child ' s mouth to verify that the medication is swallowed, child will sign a sign sheet
to record the administration of the medication, and staff will sign the MAR. In addition in case of
medication errors and/or the administration of the wrong medication or wrong dosage ingested
the Department (Office of Residential Child Care) will be notified.
(2) On September 1, 2010, a review of the agency's incident report dated August 27, 2010
revealed that Staff C inadvertently administered to Child #15 the medication Citolopram that was
intended for administration to another child.
(3) During an interview on September 9, 2010 at about 12:00 PM with Staff BB, Staff BB
acknowleged findings.
R 1222 290-2-5-.12(3)(d)3.iii. Health Services.
SS=D
[Medication use and management] policies and procedures shall include the following:
(iii) The prescribing physician shall be notified in cases of dosage errors, drug reactions, or if the psychotropic
medication does not appear to be effective. ...
This Requirement is not met as evidenced by:
Page 19 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
Based on record review and interviews with staff, the facility failed to notifying a child's
attending physician in cases of dosage errors, drug reactions, or if the prescription medication
does not appear to be effective to in 255 of 255 incidents reviewed
Findings:
(1) On September 1, 2010, a review of the agency's incident report dated August 27, 2010
revealed that Staff C inadvertently administered the Zyprexa, Benadryl, and of another child to
Child #15. The incident report reveals that Staff C notified Poison Control and the facility
"nurse." However, there is no documentation stating that the child's physician was notified. In
addition, on September 9, 2010 a review of Med Refusal Forms0 completed 1/12/10 through
8/28/10 revealed that there were more than 254 incidents of medication refusal. Furthermore,
there was no documentation stating that the resident's physician was notified of any of the
incidents.
(2) During an interview on September 9, 2010 at approximately 3:00 pm with Staff BB, Staff BB
stated that the resident's physicians were notified of these incidents. However, no evidence of
physician notification was produced. Staff BB stated that the notifications were made by
telephone and that there was "no way to document a phone call."
R 1416 290-2-5-.14(2)(a) Emergency Safety Interventions.
SS=D
Emergency Safety Interventions. Emergency safety interventions may be used only by staff trained in the proper
use of such interventions when a child exhibits a dangerous behavior reasonably expected to lead to immediate
physical harm to the child or othe
This Requirement is not met as evidenced by:
Based on review of resident files and staff interview, the agency failed to ensure when an
emergency safety intervention (ESI) is utilized, staff is trained in the proper use of such
interventions in one of one file reviewed;
Page 20 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
Findings include:
(1) Record review on September 9, 2010 of the agency's ESI log for the first quarter revealed that
Staff F was involved in the following ESI techniques: two person escort (03-06-10), one person
escort and a seated restraint (03-14-10).
(2) Record review on September 9, 2010 of the agency's ESI log for the second quarter revealed
Staff F was involved in the following ESI techniques: seated restraint (04-16-10), one person
escort (05-30-10), seated restraint (06-02-10), and one person escort (06-10-10). In addition record
review revealed that Staff G was involved in the following ESI techniques for the second quarter:
one person escort (04-11-10) and a
(3) Record review on September 9, 2010 of the agency's ESI log for the third quarter revealed
Staff F was involved in the following ESI techniques: seated restraint (07-23-10) while Staff G was
involved in a standing hold (07-26-10).
(4) Record review on September 9, 2010 of Staff F and G's file revealed that both staff received
training in Therapeutic aggression control techniques-2 (verbal certification only) from 04-28-10
to 04-30-10.
(5) During an interview on September 9, 2010 at about 2:35 pm with Staff DD, Staff DD indicated
that staff who receive Full certification of therapeutic aggression control techniques receive 2
days verbal and 1 day physical training in ESI techniques. Most staff who has received verbal
certification only may have an injury that would have prohibited the individual from engaging in
full certification in ESI techniques which involves the use of physical techniques.
R 1455 290-2-5-.14(2)(k) Emergency Safety Interventions.
SS=D
Institutions shall submit to the Department electronically or by facsimile a report, in a format acceptable to the
Department, within 24 hours whenever an unusual incident occurs regarding emergency safety interventions,
including:
1. Any injury requiri
Page 21 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
This Requirement is not met as evidenced by:
Based on record review and staff interview, the agency failed to submit to the Department within
24 hours in which three or more instances of emergency safety interventions of a specific child
occurred and/or whenever the institution has had a total of 10 emergency safety interventions
(ESIs) for all children in care within the 30-day period;
Findings include:
(1) Record review on September 9, 2010 of the agency's ESI log for the first quarter of 2010
revealed that the agency initiated 11 ESI containments in which 6 containments were assisted
relocation/escorts and 5 involved hands on restraints. Further review revealed that Resident #18
had three or more instances of ESIs (01-08-10, 01-13-10, 01-25-10, and 01-27-10) within a 30 day
period. Furthermore a review of the ESI log for the second quarter of 2010 revealed that the
agency initiated 14 ESI containments in which 9 containments were assisted relocation/escorts
and 5 involved hands on restraints. The Department has not received any reports from the
agency for the month of January-March 2010 and April-June 2010 regarding emergency safety
interventions.
(2) During an interview on September 9, 2010 at about 2:35 pm with Staff DD, Staff DD
acknowledged findings.
Page 22 of 23
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Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
9/1/2010
9/9/2010
Name of Provider or Supplier
RIDGE CREEK, INC
Street Address, City, State Zip Code
830 HIDDEN LAKE RD
DAHLONEGA, GA 30533
Inspection Results
As of: Saturday, October 30, 2010
R 9999 Closing Comments.
A brief exit conference was conducted on September 9, 2010. The investigation was completed
on September 23, 2010. There were several citations related to the allegations. A preliminary
report was e-mailed to the agency on September 24, 2010. Although a formal written plan of
correction is not due to the surveyor until 10 days after receipt of the final Statement of
Deficiencies, all citations are expected to immediately be brought into compliance with the Rules
and Regulations.
The investigation was completed on October 1, 2010. The Final Statement of Deficiency was
e-mailed to the agency on October 28, 2010. A plan of correction is due to the surveyor November
15, 2010. An office conference will be scheduled to address the agency's ongoing
noncompliance.
Page 23 of 23
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