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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 04/09/2024
Date Signed: 04/09/2024 01:20:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
02/11/2022 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20220211140048
FACILITY NAME:LONE STAR BOARD & CARE TUJUNGAFACILITY NUMBER:
197609683
ADMINISTRATOR:ALEXANDER, OTISFACILITY TYPE:
735
ADDRESS:10117 TUJUNGA CANYON BLVDTELEPHONE:
(818) 875-4501
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:35CENSUS: 33DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Rod StinsonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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1. Unlawful Eviction
2. Failure to Safeguard Resident's Belongings
3. Facility staff are financially abusing residents
4. Facility staff physically abused resident
5. Facility staff don't treat residents with dignity
6. Facility staff did not provide timely medication attention


INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) conducted a subsequent visit to deliver the final findings of the allegations mentioned above. LPA met Administrator Rod Stinson and informed them the reason of the visit. The following was determined:

Allegation # 1: Unlawful eviction: On 02/15/2022, from 1045am to 1pm, former LPA Wendell Smith conducted the initial visit and interview.On 01/26/2024, from 1130am to 130pm, LPA Tuesday Cabiness, conducted additional interviews. From the information obtained, resident #1 (R1) was having issues at the facility with a roommate. It was reported (R1) was disrespectful and aggressive toward staff and the roommate. It was also reported because of the issues with the roommate, (R1) requested to be relocated to the Licensee’s other facility in Los Angeles. LPA attempted on several occasions to contact (R1), but was not successful, it was reported to LPA that the facility where (R1) was relocated has ceased operation and no longer licensed. LPA could not obtain further information pertaining to the allegation. LPA determined based on interviews, there insufficient evidence to prove the allegation, therefore, it’s deemed Unsubstantiated at this time.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20220211140048
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LONE STAR BOARD & CARE TUJUNGA
FACILITY NUMBER: 197609683
VISIT DATE: 04/09/2024
NARRATIVE
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Allegation # 2: Failure to safeguard resident’s belongings: On 02/15/2022, from 1045am to 1pm, former LPA Wendell Smith conducted the initial visit and interview. On 01/26/2024, from 1130am to 130pm, LPA Tuesday Cabiness, conducted additional interviews. It was reported to LPA from staff, that R1 packed up all belongings when transported to the facility (R1) requested to be relocated, and that staff assisted (R1) with the relocation of (R1’s) personal belongings. It was also reported, that (R1) did not complain or report to staff at the new facility that personal belongings were missing. Staff stated if residents report missing or damaged items facility will document the item, search for the item and if not found or the item is damaged, facility would reimburse or replace the item. LPA attempted on several occasions to contact (R1) but was not successful. It was reported to LPA that the facility where (R1) was relocated has ceased operation and no longer licensed. LPA also could not obtain further information pertaining to the allegation. Based on interviews, and documents reviewed, there is insufficient evidence to prove the allegation, therefore it’s deemed Unsubstantiated at this time.

Allegation # 3: Facility staff are financially abusing residents: On 02/15/2022, from 1045am to 1pm, former LPA Wendell Smith conducted the initial visit and interviews. On 01/26/2024, from 1130am to 130pm, LPA conducted additional interviews with staff and residents. LPA also reviewed licensing reports pertaining to the allegation. Residents reported to LPA, that everyone receives their funds on time, and there are no issues or concerns. It was also reported to LPA, that (R1) did not qualify for social security benefits, and (R1’s) rent was paid through the Department of Health Services. (R1) was receiving welfare benefits, such as general relief and food stamps. LPA also determined, the alleged victim and witnesses are no longer living at the facility and LPA could not obtain further information pertaining to the allegation. Based on interviews, and documents reviewed, there is insufficient evidence to prove the allegation, therefore it’s deemed Unsubstantiated at this time.

Allegation # 4: Facility staff physically abused resident: On 02/15/2022, from 1045am to 1pm, former LPA Wendell Smith conducted the initial visit and interview. On 01/26/2024, from 1130am to 130pm, LPA conducted additional interviews with staff and residents. LPA also reviewed licensing reports pertaining to the allegation. It was alleged that staff physically assaulted a resident. LPA interviewed residents, and they reported to LPA, they have never witnessed staff physically assault any residents. Staff also deny the allegation. LPA also determined, the alleged victim and witnesses are no longer living at the facility, therefore LPA could not obtain further information pertaining to the allegation. Based on interviews, and documents reviewed, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20220211140048
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LONE STAR BOARD & CARE TUJUNGA
FACILITY NUMBER: 197609683
VISIT DATE: 04/09/2024
NARRATIVE
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Allegation # 5: Facility staff don't treat residents with dignity: 02/15/2022, from 1045am to 1pm, former LPA Wendell Smith conducted the initial visit and interview. On 01/26/2024, from 1130am to 130pm, LPA conducted additional interviews with staff and residents. LPA also reviewed licensing reports pertaining to the allegation. Residents reported to LPA that there are personality conflicts with staff, but overall, they are treated with respect and dignity. Staff deny disrespecting or mistreating residents. The alleged victim and witnesses are no longer living at the facility, and LPA could not obtain further information pertaining to the allegation. Based on interviews and documents reviewed, LPA determined there is insufficient evidence to prove the allegation and it’s deemed Unsubstantiated at this time.

Allegation # 6: Facility staff did not provide timely medication attention: 02/15/2022, from 1045am to 1pm, former LPA Wendell Smith conducted the initial visit and interview. On 01/26/2024, from 1130am to 130pm, LPA conducted additional interviews with staff and residents. LPA also reviewed licensing reports pertaining to the allegation. It was alleged that staff did not provide medical attention to a former resident (R2). LPA interviewed staff, who reported to LPA that resident # 2 (R2) had an addiction to drugs, and (R2) was found by staff unresponsive on the bathroom floor. Paramedics came and (R2) was sent to the hospital. Staff reported to LPA, (R2) was supposed to enter a drug facility, but never reported to the hospital. Staff received a visit from the local police department that (R2) was found overdosed in the street. LPA also determined that the alleged victim and witnesses are no longer living at the facility, therefore LPA could not obtain further information pertaining to the allegation. Residents currently residing at the facility did not know (R2) and did not have any information regarding (R2’s) death or could they provide additional information regarding the allegation. Based on interviews and documents reviewed, there is insufficient evidence to prove the allegation, therefore it’s deemed Unsubstantiated at this time.


Exit interview and copy of report provided.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3