019201133-4-22-2025-15-AS-YFLS-DGLNEZ-20250512102445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201133
Report Date: 04/21/2025
Date Signed: 04/22/2025 03:11:10 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/18/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20241018094556

FACILITY NAME:	NORTH STAR RESIDENTIAL HOME		FACILITY NUMBER:	019201133
ADMINISTRATOR:	ONWURAH, ANNETTE		FACILITY TYPE:	735
ADDRESS:	1429 57TH AVE		TELEPHONE:	(510) 260-9865
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY:	6	CENSUS: 3	DATE:	04/21/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Annette Onwurah, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff threatened residents
Staff did not provide meals to residents causing residents to be hungry

INVESTIGATION FINDINGS:

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On 4/22/25 at 1:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a complaint investigation and deliver findings in regard to the allegations above. LPA met with Annette Onwurah, Administrator and explained the purpose of the visit.

During the course of the investigation LPA interviewed facility residents (R2, R3 and R4) and facility staff (S1, S2 and S3).

In October of 2024 R1 alleged that she was being mistreated by staff by them not allowing her to eat her meals and threatening her. R1 no longer lives at the facility and there is no current contact information for her.

***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20241018094556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: NORTH STAR RESIDENTIAL HOME	FACILITY NUMBER: 019201133
	VISIT DATE: 04/21/2025

NARRATIVE

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***report continues from LIC9099***

LPA interviewed the residents currently residing at the facility. None of them lived at the facility when R1 was a resident.R4 is the only resident who lived at the facility at the same time as R1. R4 stated that he enjoys living at the facility and that the staff treat him "very well." R4 also stated that he has never seen staff mistreat him or the other residents. R2 and R3 also stated that they feel safe at the facility, the food is plentiful and that the staff take good care of them. Both R2 and R3 stated that have never seen staff at the facility mistreat the residents.

LPA also interviewed staff who worked at the facility during ghe time R1 was living there. S1 remembers that issues they had with R1 not following the house rules. S1 could not recall any issues around meals while R1 was at the facility. S1 stated that she feels that R1's rights were never violated and that R1 was never mistreated or threatened.

S2 and S3 stated that residents are provided with 3 meals a day and offered snacks throughout the day or as requested by the residents. Both S2 and S3 stated that they have never seen other staff mistreat or threaten the residents.

This agency has investigated the complaint alleging staff threatened residents and staff did not provide meals to residents causing residents to be hungry. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025

LIC9099 (FAS) - (06/04)

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