WELL DESERVED SUCCESS ? http://167.193.144.170:7001/ORSINV/PDFS ... F6XP11.pdfGeorgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
R 0000 Opening Comments.
The purpose of this visit was to conduct the annual re-licensure study.
R 0833 290-2-5-.08(5)(d)4. Recordkeeping. Personnel Records.
SS=C
[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:
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Based on record review and staff interview, the agency failed to provide documentation of a
complete written personnel record in one of five files. Findings include: Review of staff file D
conducted December 15, 2010 revealed that the agency failed to provide documentation of at
least two references attesting to the person's capabilities of performing the duties for which they
are employed. There were no references in the file. Staff D was hired December 21, 2009.
Interview with staff F conducted December 15, 2010 at 12:30pm acknowledged the findings.
This was previously cited December 3, 2008 and September 9, 2010.
R 0835 290-2-5-.08(5)(d)6. Recordkeeping. Personnel Records.
SS=B
[Written personnel records] records shall include the following: ...
6. Documentation from a licensed physician or other licensed healthcare professional of a health screening
examination within thirty (30) days of hiring sufficient in scope to identify
This Requirement is not met as evidenced by:
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Based on record review and staff interview, the agency failed to provide documentation of a
complete written personnel record in three of five files. Findings include: Review of staff file A,
C and D conducted December 15, 2010 revealed that the agency failed to provide documentation
Page 1 of 9
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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
of a health screening examination within thirty (30) days of hire. Staff A and C: The health
screening form was left blank in the file. Staff D: There was no documentation of a health
screening examination in the file. Staff A was hired March 15, 2010. Staff C was hired March 15,
2010. Staff D was hired December 21, 2009. Interview with staff F conducted December 15, 2010
at 12:30pm acknowledged the findings. This was previously cited September 9, 2010.
R 0851 290-2-5-.08(6)(d) Staffing.
SS=D
Staff Training. Prior to working with children, all staff, including the director, who work with children and are hired
after the effective date of these rules shall be oriented in accordance with these rules and shall thereafter
periodically receive addi
This Requirement is not met as evidenced by:
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{ TX_RTF32 14.0.520.503;
Based on record review and staff interview, the agency failed to provide documentation of staff
training prior to working with children in three of five files. Findings include: Review of staff
file A, C and D conducted December 15, 2010 revealed that the agency failed to provide staff
training prior to working with children. Staff A: Training was completed April 27, 2010, over one
month after hire. Staff A was hired March 15, 2010. Staff C: The agency provided a forty (40)
hour "Orientation" certificate dated June 10, 2010, over three months after hire. Staff C was hired
March 15, 2010. Staff D: There was no documentation of staff training in the file. Staff D was
hired December 21, 2009. Interview with staff F conducted December 15, 2010 at 12:30pm
acknowledged the findings.
R 0852 290-2-5-.08(6)(d)1. Staffing.
SS=D
[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:
Page 2 of 9
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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
[Normal];{ Default Paragraph Font;
{ TX_RTF32 14.0.520.503;
Based on record review and staff interview, the agency failed to provide documentation of a
completed staff orientation in two of five files. Findings include: Review of staff file C and D
conducted December 15, 2010 revealed that the agency failed to provide a complete staff
orientation to include the following: Staff C: A forty (40) hour "Orientation" certificate dated
June 10, 2010. The certificate did not include documentation of instruction in the following areas:
Purpose and description of services; Employees assigned duties and responsibilities;
Grievance policies and procedures; Child abuse policies and procedures; Reporting
requirements for suspected cases of child abuse, sexual exploitation, notifiable diseases and
serious injuries; Policies and procedures for handling medical emergencies and managing use
of medication; Policies and procedures regarding appropriate behavior management and
emergency safety interventions. There was no other documentation of staff orientation in the
file. Staff D: There was no documentation of staff orientation in the file. Staff C was hired
March 15, 2010. Staff D was hired December 21, 2009. Interview with staff F conducted
December 15, 2010 at 12:30pm acknowledged the findings.
R 0859 290-2-5-.08(6)(d)2. Staffing.
SS=B
Additional training shall include twenty-four (24) clock hours of formal, annual training or instruction in child care
issues related to the employee's job assignment and to the types of services provided by the institution.
This Requirement is not met as evidenced by:
Based on record review and staff interview, the agency failed to provide documentation of
twenty-four (24) hours of annual training in three of five files.
Findings include:
Review of staff file B , D and E conducted December 15, 2010 revealed that the agency failed to
provide twenty-four (24) hours of annual training or instruction in child care issues in the file.
Staff B : There was 1.5 hours of annual training in the file. There was no additional training
documentation in the file.
Page 3 of 9
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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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
Staff D: There was 8.5 hours of annual training in the file. There was no additional training
documentation in the file.
Staff E: There was no documentation of annual training in the file.
Staff B was hired July 28, 2008. Staff D was hired December 21, 2009. Staff E was hired January
3, 2008.
Interview with staff F conducted December 15, 2010 at 12:30pm acknowledged the findings.
This was previously cited December 3, 2008.
R 1000 290-2-5-.10(1) Assessment and Planning.
SS=C
An institution shall complete a full written assessment of each child admitted for care and of each child's family
within thirty days of admission and develop an individual written service plan for each child based on the
assessments within thirty days of
This Requirement is not met as evidenced by:
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Based on record review, the agency failed to provide documentation of a completed assessment
within thirty days of admission in two of three files. Findings include: Review of resident file #1
and #2 conducted December 14, 2010 revealed that the agency failed to provide an assessment
"Psych Social Evaluation" within thirty days of admission. Resident #1: Completed November
29, 2010, over one month later than the due date. Resident #2: There was no assessment in the
file. Resident #1 was admitted to the program October 21, 2010. Resident #2 was admitted to the
program August 30, 2010. Interview with staff F conducted December 14, 2010 at 2:15pm
acknowledged the findings. This was previously cited December 3, 2008 and December 10,
2010.
R 1001 290-2-5-.10(a) Assessment and Planning.
Page 4 of 9
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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
SS=C
The facility ' s admission evaluation shall be coordinated by the child's designated Human Services Professional.
The facility shall assess the needs of the child in the areas of health care, room, board and watchful oversight,
education, family relations
This Requirement is not met as evidenced by:
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{ TX_RTF32 14.0.520.503;
Based on record review and staff interview, the agency failed to provide documentation of a
complete assessment in three of three files Findings include: Review of resident file #1, file #2
and file #3 conducted December 14, 2010 revealed that the agency did not document a complete
assessment "Psych Social Evaluation" in the file. The agency failed to include the following in
the "Psych Social Evaluation" assessment: Resident #1: Health care, education, personal and
social development and behavioral issues "Psych Social Evaluation" dated November 29, 2010.
Resident #2: There was no assessment in the file. Resident #3: Education (not adequate)
agency documented the names of the school, personal development (not mentioned) "Psych
Social Evaluation" dated August 11, 2010. Interview with staff F conducted December 14, 2010 at
2:15pm acknowledged the findings. This was previously cited December 3, 2008 and December
10, 2009.
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:
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Based on record review and staff review, the agency failed to provide documentation of a
completed service and room, board and watchful oversight (RBWO) plan developed by the
Human Services Professional in three of three files. Findings include: Review of resident file
#1, #2 and #3 conducted December 9, 2010 revealed that the agency failed to document a
complete RBWO plan in the file. The following was not documented in the " Individual Service
Plan" dated November 29, 2010 (8 days late) resident #1, September 20, 2010 for resident #2 and
Page 5 of 9
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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
August 11, 2010 for resident #3: Resident #1: 1. Activities to be followed by the staff in pursuit
of the goals and objectives; 2. Goals and preliminary plans for discharge (not clear); 3. Types of
discipline that should be used (not mentioned); Resident #2: 1. Methods of evaluating the goals
and objectives for problem #2 vocational and #3 residential (not clear); 2. Goals and preliminary
plans for discharge (not clear); 3. Types of discipline that should be used (not mentioned); 4.
Restrictions of communication and visitations (not clear). Resident #3: 1. Methods of evaluating
the goals and objectives for problem #2 vocational and #3 residential (not clear); 2. Goals and
preliminary plans for discharge (not clear); 3. Types of discipline that should be used (not
mentioned); 4. Restrictions of communication and visitations (not clear). Interview with staff F
conducted December 14, 2010 at 2:15pm acknowledged the findings. This was previously cited
July 21, 2010, September 9, 2010 and November 5, 2010.
R 1010 290-2-5-.10(c) Assessment and Planning.
SS=C
The child, and the parent(s) or guardian(s), or child placing agency representative shall be involved in the
development of the service and room, board and watchful oversight plans, and its periodic updates as described
below.
This Requirement is not met as evidenced by:
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Based on record review and staff interview, the agency failed to provide documentation of the
involvement of the child and the parent(s) in the development of the service and room, board and
watchful oversight (RBWO) plan in three of three files. Findings include: Review of resident file
#1, #2 and #3 conducted December 14, 2010 revealed that the agency failed to document the
involvement of the child and parent(s) in the service and room, board and watchful oversight
(RBWO) plan "Individual Service Plan" dated November 29, 2010 for resident #1, September 20,
2010 for resident #2 and August 11, 2010 for resident #3. The agency documented one request
on November 29, 2010 for parent involvement for resident #3. Interview with staff F conducted
December 14, 2010 at 2:15pm acknowledged the findings. This was previously cited December
10, 2009 and November 5, 2010.
R 1102 290-2-5-.11(3) Discharge and Aftercare.
SS=C
Page 6 of 9
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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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
When a child is discharged, an institution shall compile a complete written discharge summary within thirty days of
the discharge. Such summary shall include:
(a) The name, address, telephone number and relationship of the person or entity to whom the chi
This Requirement is not met as evidenced by:
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{ TX_RTF32 14.0.520.503;
Based on record review and staff interview, the agency failed to provide documentation of a
complete written discharge summary. Findings include: Review of resident file #4 on
December 14, 2010 revealed that the agency failed to provide a complete discharge summary
dated August 19, 2010 in the file. The agency failed to include the following: 1. Name, address,
telephone number and relationship of the person to whom the child was discharged (not
mentioned); 2. Family goals, objectives and accomplishments (not mentioned); Interview with
staff F conducted December 14, 2010 at 2:15pm acknowledged the findings. This was
previously cited December 3, 2008 and December 10, 2009.
R 1200 290-2-5-.12(1) Child Care Services.
Casework Services. All children in care and families of children in care shall receive case work services as
provided in their service plan from their assigned Human Services Professional or other appropriate professionals
who shall meet with and counsel
This Requirement is not met as evidenced by:
Based on record review and staff interview, the agency failed to provide documentation of case
work services from the Human Services Professional or other appropriate professionals in three
of three files.
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:
Page 7 of 9
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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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
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{ TX_RTF32 14.0.520.503;
Based on record review and staff interview, the agency failed to provide documentation of
complete basic diagnostic laboratory work in two of three files. Findings include: Review of
resident file #1 and #2 conducted December 14, 2010 revealed that the agency failed to document
complete basic diagnostic laboratory work in the file. The agency failed to include the following:
Resident #1: There was no documentation of a hearing test in the file. Resident #2: There was
no documentation of a Complete Blood Count(CBC), basic urinalysis, vision and hearing tests in
the file. Interview with staff F conducted December 14, 2010 at 2:15pm acknowledged the
findings. This was previously cited December 10, 2009 and September 9, 2010.
R 1224 290-2-5-.12(3)(d)5. Health Services.
SS=B
[Medication use and management] policies and procedures shall include the following: ...
5. An institution shall maintain a record of all medications handed-out by authorized staff and taken by children to
include: name of child taking medication, name of
This Requirement is not met as evidenced by:
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{ TX_RTF32 14.0.520.503;
Based on review of agency documentation and staff interview, the agency failed to maintain a
complete record of all medications handed-out by authorized staff and taken by children.
Findings include: Review of medical record #2 conducted December 15, 2010 revealed that the
agency failed to maintain a complete record of all medication handed-out by staff and taken by
the children. There was no documentation of the date and time taken, dosage taken, name and
signature of staff member for the following medication: Resident #2: Amphetamin ER 20mg
TEV (generic for Adderall) 1 tablet (not given 12-1-10 to 12-6-10). There was no other
documentation in the file. Interview with staff F conducted December 15, 2010 at 12:30pm
acknowledged the findings and revealed that the agency had to get approval from the parents to
administer the medication, Amphetamin ER 20mg TEV. This was previously cited December 10,
2009.
R 9999 Closing Comments.
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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:
12/14/2010
12/15/2010
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: Wednesday, January 19, 2011
{ TX_RTF32 14.0.520.503;
A brief exit conference was conducted on site. Although a formal written plan of correction is not
due to the surveyor until receipt of the final statement of deficiencies, all citations are expected
to immediately be brought into compliance with the rules and regulations. This is the final
report. The final report was e-mailed January 19, 2011. A plan of correction is due the Surveyor
by February 1, 2011.
Page 9 of 9
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