Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
11/23/2010
12/9/2010
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, December 25, 2010
R 0000 Opening Comments.
The purpose of this survey is to conduct an investigation for self reported incident #GA00089613
and self reported incident #GA00089358.
R 0861 290-2-5-.08(7) Staffing.
SS=B
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 Office of Residential Child Care within 24 hours for one of two incidents
reviewed. #GA89358
Findings Include
1) Review on 11/23/2010 at 8:00 am of intake report, submitted on 11/8/2010, revealed that on
11/4/2010 at 10:00am, Resident #1 reported to staff that on 10/29/10 Resident #2 got into his/her
bed and performed a sexual act on him/her. This report stated that Resident #1 said Resident #2
threatened him/her if he/she told anyone.
2) During interview with Staff A on 11/23/2010 at 3:15 pm, he/she stated that this incident was
reported outside the 24 hours requirement because he/she didn't think the incident was
reportable until after the police were involved.
3) Review on 11/23/2010 at 2:20 pm of Resident #2's Incident Report, dated 10/17/2010, revealed
that he/she grabbed another resident inappropriately because the resident sat on Resident #2's
face without clothing on. This report stated that the other resident was bleeding as a result of
Resident #2 pinching him/her.
Page 1 of 4
More Information Return to Facility Location and Information Guide Return to Inspection Screen
Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
11/23/2010
12/9/2010
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, December 25, 2010
4) Review on 11/23/2010 at 2:20 pm of Resident #4's incident report, dated 9/3/2010 at 11:15 pm,
revealed that Resident #4 had scratches from his/her wrist to his/her elbow on the inner side of
his/her left forearm. This report stated that Resident #4 said he/she wanted to use glass, but was
on 1:1 supervision all day. According to this report, Resident #4 had done the self harming with
a rock and hid it in his/her underwear. This report stated that a full body search was conducted
and a quarter size rock with blood was recovered. The scratches were cleaned and wrapped.
5) Review on 11/23/2010 of Resident #4's incident report, dated 9/7/2010, revealed that staff
entered the academic building and noticed Resident #4 holding his/her arm and showing signs of
pain. The report indicated that staff noticed Resident #4's forearm was bleeding and Resident #4
stated that he/she picked at scars to reopen his/her wounds. The staff cleaned and bandaged
Resident #4's arms.
6) Review on 12/9/2010 at 9:00 am of Aspen Complaints/Incident Tracking System, revealed that
the 9/3/2010, 9/7/2010, and 10/17/2010 incidents were not reported to the Office of Residential
Child Care.
On 12/9/2010 at 3:19 pm via, Staff A was informed of the citation for not reporting the 9/3/2010,
9/7/2010, and 10/17/2010 incidents.
This tag was previously cited on 9/9/2010.
R 0862 290-2-5-.08(7)(a-g) Staffing.
SS=B
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;
(
Page 2 of 4
More Information Return to Facility Location and Information Guide Return to Inspection Screen
Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
11/23/2010
12/9/2010
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, December 25, 2010
This Requirement is not met as evidenced by:
Based on record review and staff interview, the agency failed to submit a report regarding
serious occurrences involving children in care.
Findings Include
1) Review on 11/23/2010 at 2:20 pm of Resident #4's incident report, dated 9/3/2010 at 11:15 pm,
revealed that Resident #4 had scratches from his/her wrist to his/her elbow on the inner side of
his/her left forearm. This report stated that Resident #4 said he/she wanted to use glass, but was
on 1:1 supervision all day. According to this report Resident #4 had done the self harming with a
rock, which he/she hid in his/her underwear. This report stated that a full body search was
conducted and a quarter size rock with blood was recovered. The scratches were cleaned and
wrapped.
2) Review on 11/23/2010 of Resident #4's incident report, dated 9/7/2010, revealed that Resident
#4 had self harmed. This report stated that Staff entered the academic building and noticed
Resident #4 holding his/her arm and showing signs of pain. The report indicated that the staff
noticed that Resident #4's forearm was bleeding and Resident #4 stated that he/she picked at
scars to reopen his/her wounds.
3) Review on 11/23/2010 at 2:20 pm of Resident #2's Incident Report, dated 10/17/2010, revealed
that he/she inappropriately touched a resident because the resident sat on Resident #2's face
without clothing on. This report stated that the other resident was bleeding as a result of
Resident #2 pinching.
4) Review on 12/9/2010 at 9:00 am of Aspen Complaints/Incident Tracking System, revealed that
the above three incidents were not reported to the Office of Residential Child Care.
On 12/9/2010 at 3:19 pm via email correspondence, Staff A was informed of this citation.
This tag was previously cited on 9/9/2010.
R 9999 Closing Comments.
Page 3 of 4
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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:
11/23/2010
12/9/2010
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, December 25, 2010
An exit conference was conducted onsite on 11/23/2010 and offsite on 12/9/2010. There were two
citations found during the investigations. There was one citation related to the self reported
incident #GA00089358. There were no citations related to the self reported incident
#GA00089613. The preliminary report was e-mailed on 12/2/2010. The final report was e-mailed on
12/22/2010 and plan of correction is due 1/7/2011.
Page 4 of 4
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