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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 06/05/2025
Date Signed: 06/05/2025 02:14:59 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
05/30/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250530100154
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: 23DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Rod Stinson - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are mismanaging residents medication

Staff are not ensuring the facility is kept clean



INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Rod Stinson and explained the reason for the visit.

LPA conducted physical plant tour at 9:34 AM, requested copies of facility documents relevant to the investigation at 10:01 AM, reviewed records between 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM to 1:00 PM. Regarding the allegation that Staff are mismanaging residents’ medication, it was alleged that case manager is handing out medications until the nurse arrives at 11am. LPA's record review at 10:30 AM revealed that that Staff #1 (S1) or the "case manager" is a certified ARF administrator and therefore had training in medication administration. Further review also revealed that some designated staff administering medication was trained internally by the facility Registered Nurse (RN) and externally from State Vendored training company. During today's visit, LPA observed that medications are kept locked in the medication room where the RN holds office. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20250530100154
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: 06/05/2025
NARRATIVE
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(continued from LIC 9099)

Regarding the allegation that Staff are not ensuring the facility is kept clean, it was alleged that facility is dirty (crumbs, stains, bed pads disposed of in trash in front of activity room). LPA's observation during visit revealed that the facility is generally clean all over. LPA observed that the housekeeper was cleaning a room during physical plant tour and other residents are cleaning their own room. LPA's interview with the Administrator revealed that the housekeeper cleans the common areas everyday including emptying the trash in the common areas but there are times that the housekeeper comes in from 9:00 AM to 5:00 aside from the housekeeper's usual schedule at 7:30 AM to 3:30 PM. Further, when the housekeeper is off or absent, the regular staff clean the common areas.

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: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3