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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609683
Report Date: 11/18/2021
Date Signed: 11/18/2021 12:03:03 PM

Document Has Been Signed on 11/18/2021 12:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gio Monico & Rod StinsonTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility to conduct an unannounced infection control inspection/visit. Upon arriving, LPA was greeted by the Co-Administrator Gio Monico, who asked LPA to sign in. Temperature was taken, COVID screening questions were asked; and hand sanitizer located at the front desk. At the same time, Administrator Rod Stinson arrived, and both were informed the reason of the visit. There have not been any active or past COVID cases at the facility since December 2020; 97.0% of clients are vaccinated, and over 85% staff have been vaccinated. There has not been any recent discussions with staff or clients pertaining to the COVID boosters; but the facility has resources in place to begin the process. The current census is (31). LPA observed staff and clients to have full mask covering, and clients were sitting in the common area watching TV, and practicing social distancing. COVID-19, CDC, Department of Public Health, and Licensing postings, in various languages, were visible seen and posted on the walls throughout the facility. All staff and client bathrooms have hand washing signs.

The infection control inspection began with both Administrators Gio Monico and Rod Stinson; who escorted LPA throughout the facility, discussed the mitigation plan submitted to Licensing. The facility is one level building, client rooms are on both sides. Women rooms are right side of the building, and the men are on the left. The common areas were observed to be clean, including client rooms; staff, visitor, and client bathrooms. Soap and towels, and hand washing signs were visually posted. The facility has cleaning procedures and protocols in place, which include staff cleaning common areas three times a day; including highly touched areas, such as door knobs and walls. There are community updates provided to clients weekly, to communicate any new changes or procedures that are being implemented, pertaining to COVID-19. Currently, the Administrator has requested all clients to continue wearing masks daily. The Administrator reported to LPA, the facility has documentation

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.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
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of all vaccination records and other pertinent information pertaining to COVID-19, in staff and client files. All new employee hires and new client admits, will be properly screened, and must provide a negative COVID test; prior to entering the facility. The facility current vaccination policy, recommends staff and new admits to be vaccinated; but not required; except must have negative COVID test. The facility continues to surveillance test, the (3) resident who are not vaccinated. The test is conducted in-house; but at this time, there nurse consultant has not been available and they have not tested in the last (3) weeks. They will resume, when there nurse returns. If there are any signs or symptoms from residents or clients, the facility has a rapid test kits in place. Administrator Rod reported to LPA, that he has not received all departmental emails. LPA changed contact information within the department's database (LIS). Facility continues to provide and conduct in-service training to staff in relation to COVID-19 and other required training. Staff are provided monthly vacation and sick leave. The facility does not have staffing issues. There is a designated area for potential positive COVID clients.

PPE supplies were inspected, and Administrators reported to LPA that the supplies are kept in the storage area, and weekly stocked with supplies. The facility continues to implement the best practices for the facility; to ensure the health and safety of clients and staff.

The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases.

Exit interview was conducted and copy of report provided.

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
LIC809 (FAS) - (06/04)
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