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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 11/18/2021
Date Signed: 11/18/2021 02:58:27 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
11/08/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20211108111850

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: 31DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Gio Monico & Rod StinsonTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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1 Staff are not ensuring client is adequtely hydrated
2. Client is not being adequately fed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Co-Administrators Gio Monico and Rod Stinson and informed them the reason of the visit. The following was determined:

Allegation # 1: Staff are not ensuring client is adequately hydrated: From 1130am to 3pm, a physical plant inspection was conducted, and LPA reviewed facility documents; and interviewed clients and residents. Through information obtained and observations, the facility has a water cooler and cups in the common area for all clients when needed. LPA checked the cooler and found it to be full of water. LPA also conducted interviews, and it was revealed, that staff full the cooler daily with fresh water for clients. The facility also provides a vending machine for clients to purchase water and soft drinks. Therefore, based on interviews and observations, the allegation, “Staff are not ensuring client is adequately

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20211108111850
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: 11/18/2021
NARRATIVE
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hydrated” is UNSUBSTANTIATED at this time.

Allegation # 2: Client is not being adequately fed: From 1130am to 3pm, a physical plant inspection was conducted, and LPA reviewed facility documents; and interviewed clients and residents. Through information obtained and observations, LPA inspected the facility’s non-perishable and perishable items for the clients in care. It was determined that the facility provides an ample amount of food for clients, and the facility was within Licensing requirements for food regulations. LPA interviewed staff and clients, who revealed, the facility provides, (3) meals a day, and (2) snacks. LPA received and reviewed the daily menu. Facility also provides a vending machine for clients to purchase snacks and soft drinks. Therefore, based on observations and interviews, the allegation “Client is not being adequately fed” is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3