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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 10/08/2024
Date Signed: 10/08/2024 01:32:17 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
10/02/2024 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20241002112506
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: 27DATE:
10/08/2024
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Rod Stinson - AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff are not properly addressing pest infestation in facility

Facility staff member is mishandling client's funds
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Gary Tan and Angelica Segovia conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPAs met with administrator Rod Stinson and explained the reason for the visit.

LPAs conducted physical plant tour at 9:39 AM, requested copies of facility documents relevant to the investigation at 10:16 AM, interviewed staff and residents between 10:30 AM to 12:30 PM and reviewed records from 12:30 PM to 1:00 PM. It was alleged that Resident #1 (R1) complained of bed bugs on 09/28/24. LPAs' interview with the administrator today revealed that once the administrator received the report, the bed infested with bed bugs was immediately removed together with other infested personal belongings of R1 and the room was treated on the night of 09/28/24, twice. LPAs' record review also revealed that a follow up treatment on 10/04/24 was done to treat the infested room. LPAs observation during physical plant tour confirmed that R1 has a new bed and box springs and sleeping at the new bed during visit. (continued on LIC 9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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-20241002112506
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: 10/08/2024
NARRATIVE
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(continued from LIC 9099)

Further record review also revealed that Los Angeles County Department of Public Health (LACDPH) inspected the facility for bed bugs on 10/04/24 and cleared the facility of bed bugs.

Regarding the allegation that Facility staff member is mishandling client's funds, it was alleged that Staff #1 (S1) held residents' Personal & Incidences (PNI) money from the residents. LPAs' record review today between 12:30 PM to 1:00 PM revealed that there are seven (7) residents currently receiving PNI from the facility and seven (7) out of seven (7) residents' record reviewed have their PNI money received and signed for every month. LPAs interview with four (4) PNI recipient today between 10:30 AM to 12:30 PM confirmed that all four (4) of them are receiving their PNI regularly and no one in the facility is holding their money. Three (3) recipient residents were not interviewed as they were at the day program during visit.

Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3