197609683-2-1-2022-31-AS-CHAS-CBMRN7-20220214120951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 02/01/2022
Date Signed: 02/01/2022 01:45:35 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2022 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220131114405

FACILITY NAME:	LONE STAR BOARD & CARE TUJUNGA		FACILITY NUMBER:	197609683
ADMINISTRATOR:	ALEXANDER, OTIS		FACILITY TYPE:	735
ADDRESS:	10117 TUJUNGA CANYON BLVD		TELEPHONE:	(818) 875-4501
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY:	35	CENSUS: 32	DATE:	02/01/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Gio Monico		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff failed to provide adequate food service
Facility staff failed to treat resident with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with facility staff and explained the reason for this visit.

Facility staff failed to provide adequate food service
It is alleged that facility does not serve snack or allow clients to use the microwave. LPA conducted a physical plant walk through of the facility from 9:45-10:10am. During the walk through LPA checked the kitchen area for the ability to prepare and store food. LPA conducted interviews with clients and staff from 10:10am-11:30am regarding this allegation. Interviews revealed that clients are served snacks at 2pm and at 7pm. Clients interviewed also stated they are able to heat up their food using a microwave in the kitchen area. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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 31-AS-20220131114405

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LONE STAR BOARD & CARE TUJUNGA	FACILITY NUMBER: 197609683
	VISIT DATE: 02/01/2022

NARRATIVE

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Facility staff failed to treat resident with respect
It is alleged that staff threw client #1 (C1) food away for no reason. LPA conducted interviews with C1, clients, and facility staff. Interviews revealed that C1 brought a pizza and had it delivered to the facility. C1 wanted to eat the pizza in their room but was unable to so ate the pizza outside and shared it with other clients. After that C1 came and put the pizza on the staff's desk while no one was in the staff's office. Staff then questioned C1 regarding why the pizza was placed on staff's desk. C1 then placed the pizza in the hallway and after a few hours believing the pizza was done staff threw the pizza away. Based on the information obtained this allegation is deemed Unsubstantiated at this time.
No deficiencies cited. Exit Interview conducted.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

LIC9099 (FAS) - (06/04)

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