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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:56:37 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
10/03/2024 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20241003134741
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: 25DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Rod Stinson - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff confiscated resident’s wheelchair as a form of punishment
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Administrator Rod Stinson and explained the reason for the visit.

LPA conducted physical plant tour at 9:24 AM, requested copies of facility documents relevant to the investigation at 9:58 AM and interviewed staff and residents between 10:30 AM to 12:30 PM. It was alleged that Staff #1 (S1) took away Resident #1 (R1)'s wheelchair as a form of punishment. LPA's interview with R1 on 10/08/24 between 1:45 PM and 2:10 PM and today at 10:48 AM revealed that no staff has taken away R1's wheelchair from R1. LPA's interview with Resident #2 (R2) who is R1's roommate, revealed that R2 did not see or heard S1 or any staff taking R1's wheelchair from R1. LPA's interview with three (3) more residents today between 10:30 AM to 12:30 PM or a total of four (4) residents or more than 10% of the current census, did not witness S1 or any staff taking R1's or any wheelchair bound residents at the facility. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 2
Control Number 31-AS-20241003134741
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: 12/12/2024
NARRATIVE
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(continued from LIC 9099)

LPA's interview with S1 today at 1:02 PM also revealed that R1 is able to walk with a walker and had a habit of going to other resident's room one by one at night to ask for illegal drugs. LPA's observation during visit on 10/08/24 and today revealed that R1 indeed is able to ambulate through a walker and walk around the facility. S1 denied taking away R1's wheelchair as a form of punishment to R1 as it would have been useless as R1 was able to ambulate via own walker.

Based on the information gathered during this and prior visit, the allegation is 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: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2