Georgia Department of Human Resources,
Office of Regulatory Services State Form
Statement of Deficiencies
and Plan of Correction
Inspection begin date
Inspection end date:
3/7/2011
4/7/2011
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, May 7, 2011
R 0000 Opening Comments.
The purpose of this survey is to conduct an investigation for self reported incident #GA00093270
and complaint #GA00093772.
R 0801 290-2-5-.08(2) Administration and Organization.
SS=F
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:
Findings Include
Review on 3/14/2011 at 12:25 pm of the agency's Admission Requirements (15-100.0), revealed
that the agency does not accept adolescents diagnosed with Conduct Disorder or who would fit
the profile of Conduct Disorder, adolescents who have felony arrest records, adolescents who
have a history of violence against people or animals.
Review on 3/14/2011 at 12:25 pm of Resident #1's Intake Summary, stated that he/she has an
arrest history for unruly child and has a charge pending for family violence. The agency failed to
obtain documentation as whether the charge was a misdemeanor or felony to determine if
Resident #1 met the criteria for admission.
Review on 3/14/2011 at 12:25 pm of Resident #1's application, dated 6/28/2010, revealed that
he/she has pending charges for family violence.
Interview with Resident #1 was conducted on 3/14/2011 at 6:26 pm. Resident #1 said he/she has
a charge for pushing his/her parent prior to placement. Resident #1 said he/she has had 3 felony
charges for possession.
Review on 3/14/2011 at 3:00 pm of Resident #3's Intake Summary, revealed that his/her issues
are the following: ADHD, Aggressive behavior toward his/her parent and friends, anxiety, arrest
history for marijuana possession, drug use, theft, promiscuity.
Page 1 of 5
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:
3/7/2011
4/7/2011
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, May 7, 2011
Review on 3/14/2011 at 3:00 pm of Resident #3's Application for Enrollment, dated 3/23/2010,
revealed that he/she most recently got into a physical fight with a friend over a someone he/she
was dating. The application stated that Resident #3 was taken to the police and was under house
confinement at the time. The application then stated that in 3/2008, R#3 hurt his/her parent by
twisting his/her arm. This application stated that Resident #3 received battery charges for hurting
his/her parent which was dismissed; 2009 possession of marijuana where he/she completed a
diversion program; March 2010 burglary with battery which he/she is in the process of getting the
charge dismissed. Although the agency did not have documentation as to whether Resident #3's
charges are misdemeanor or felony, he/she still did not met the criteria for placement due to
his/her violence against his/her parent and his/her friend.
Review on 3/14/2011 at 3:00 pm of Resident #3's psychiatric referral summary from a hospital,
dated 3/10/2010, revealed that he/she was diagnosed with Conduct Disorder making him/her
ineligible for placement in accordance to agency's admission policy. This report stated that
he/she was admitted for potential for violence.
Interview with Resident #3 was conducted on 3/14/2011 at 4:55 pm. Resident #3 said she/he
came to placement from jail because he/she was suppose to go to prison for felony assault for
beating up a kid (1st degree assault). Resident #3 said his/her parents agreed to allow him/her to
get out of his/her home state for six months. Resident #3 stated that his/her parents found this
placement and presented it to the judge.
During interview with Staff A on 3/14/2011 at 4:00 pm, he/she acknowledged the findings.
This rule was previously cited on 3/10/2011 and 9/9/2010.
R 0834 290-2-5-.08(5)(d)5. Recordkeeping. Personnel Records.
Page 2 of 5
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:
3/7/2011
4/7/2011
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, May 7, 2011
SS=E
[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:
Findings Include
Review on 3/14/11 at 1 pm of Resident #4's file, dated 10/22/10, revealed that he/she is 18 years
of age and does not have a criminal records check.
Review on 3/14/11 at 2 pm of Resident #7's file, revealed that he/she is 18 years of age and does
not have a criminal records check.
During interview with Staff A on 3/14/2011 at 4:00 pm, acknowledged the findings. Staff A was
allowed to forward the criminal records check if found in another location. As of 4/11/2011, the
missing criminal records checks have not been received.
This rule was previously cited on 9/9/2010.
R 1003 290-2-5-.10(b) Assessment and Planning.
SS=F
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 record review and staff interview, the agency failed to document a complete service
and room, board and watchful oversight plan in two of seven files reviewed.
Findings Include
Page 3 of 5
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:
3/7/2011
4/7/2011
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, May 7, 2011
Record review on 3/14/2011 at 12:25 pm of Resident #2's file, revealed that he/she did not have a
Room, Board, and Watchful Oversight Plan (RBWO) within 30 days of placement. Resident #2
was admitted over three months ago.
During interview with Staff A on 3/14/2011 at 4:00 pm, he/she acknowledged the findings and did
not specify reasons for delay in development of RBWO plan.
Review on 3/14/2011 at 12:25 pm of Resident #'6's Individualized Service Plan, dated 8/6/2010,
revealed statements of any special care and services was not addressed.
Record review on 3/14/2011 at 12:25 pm of Resident #6's Individual Service Plan, dated
10/19/2010, revealed that he/she meets the eligibility criteria for special educational services in
the area of emotional and behavioral disorder. According to this plan, Resident #6 is eligible for
educational services until next review on 5/25/2011. The review also revealed revealed that
his/her Individualized Education Program was not addressed. Resident #6 was admitted over five
months ago.
During interview with Staff A on 3/14/2011 at 4:00 pm, he/she acknowledged the findings.
This rule was previously cited on 11/5/2010, 9/9/2010, and 7/21/2010.
R 1011 290-2-5-.10(d) Assessment and Planning.
SS=C
The service and room, board and watchful oversight plan shall be updated by the Human Services Professional at
a minimum of every six months and pertinent progress notes and data shall be incorporated in the plan to
Page 4 of 5
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:
3/7/2011
4/7/2011
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, May 7, 2011
measure attainment of stated goals and
This Requirement is not met as evidenced by:
of seven files reviewed.
Findings Include
Record review on 3/14/2011 at 12:25 pm of Resident #3's Individual Service Plan, dated 8/2010,
revealed that his/her Room, Board, and Watchful Oversight (RBWO) goals expired on 11/2010. An
Individual Service Plan completed after 8/2010 was not found in Resident #3's file. Resident #3
was admitted nearly one year ago.
Record review on 3/14/2011 at 12:30 pm of Resident #1's Individual Service Plan dated 7/2010,
revealed that his/her RBWO goals, expied on 9/2010. An Individual Service Plan completed after
7/2010 was not found in Resident #1's file. Resident #1 was admitted nearly nine months ago and
discharged over two weeks ago.
During an interview with Staff A on 3/14/2011 at 4:00 pm, he/she acknowledged the findings.
This rule was previously cited on 7/21/2010 and 12/10/2009.
R 9999 Closing Comments.
An exit conference was conducted onsite on 4/20/2011. There were four rule violations found
during the investigation and one rule violation related to complaint #GA93772 associated with
self reported incident #GA93270. The preliminary report was e-mailed on 3/24/2011. The plan of
correction will be due within 10 days of receipt of this final survey.
Page 5 of 5
More Information Return to Facility Location and Information Guide Return to Inspection Screen