<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 03/15/2022
Date Signed: 03/15/2022 04:46:05 PM

Substantiated


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
03/07/2022 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20220307113017
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: 32DATE:
03/15/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gio Monico & Rod StinsonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Unlawful Eviction
2. Failure to Safeguard Resident's Belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced initial complaint visit, to discuss the allegations mentioned above. LPA was greeted by case manager Gio Monico, who was informed the reason of the visit. The Administrator Rod Stinson arrived shortly after but was not stay for the visit. The following was determined:

Allegation # 1: Unlawful eviction: It is alleged that the facility issued an unlawful eviction to client # 1(C1). LPA conducted interviews, reviewed facility and client file documents, C1’s eviction notice, emails to C1’s responsible party, as well as a reviewed a video, on 03/11/2022, 03/14/2022, 03/15/2022, from various times of the day, ranging from 8am to 4pm. In review of Title 22 Regulations, the eviction notice was missing information, such as specific facts supporting the reason for the eviction including the date, place, and witnesses. The facility also did not properly send a copy of the notice to C1’s responsible party
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
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 6
Control Number 31-AS-20220307113017
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: 03/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Therefore, due to the information missing in the eviction notice, and not properly notifying the responsible party, the allegation is “Unlawful eviction” is Substantiated.

Allegation # 2: Failure to Safeguard Resident's Belongings: It was reported that facility staff did not safeguard client’s (C1)’s belongings and personal property. LPA conducted interviews, reviewed facility and client file documents, C1’s eviction notice, emails to C1’s responsible party, as well as a reviewed a video, on 03/11/2022, 03/14/2022, 03/15/2022, from various times of the day. On 02/11/2022, C1 was issued a (30) day eviction notice. The eviction notice was set to expire on 03/11/2022, in which on that day, C1 was preparing to move out. Interviews and video revealed, C1’s personal belongings were gathered and placed in trash bags. LPA observed C1’s personal property satiated with liquid from ‘Cup O’Noodles’. LPA also observed other personal items to be soaked. It was reported to LPA that staff did not allow C1 to remove C1’s personal property, and staff did not take appropriate measures to ensure that R1's personal belongings were gathered properly and transferred to trash bags. Facility also did not properly inventory all C1’s belongings during C1’s residency at the facility. Therefore, based on the video and interviews, the allegation “Failure to Safeguard Resident’s Belongings” is Substantiated.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 31-AS-20220307113017
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/16/2022
Section Cited
CCR
80068.5(c)(d)
1
2
3
4
5
6
7
Eviction Procedures:(c)The notice... shall state...the reason for the eviction including the date, place, witnesses, if any, and circumstances.(d)...the licensee, shall on the same day, overnight mail or fax a copy of
1
2
3
4
5
6
7
Administrator will research vendorized training from Community Care Licensing agencies to conduct training dealing Title 22 Regulations on eviction procedures. Email of information needs to be provided by
8
9
10
11
12
13
14
of the notice...if any or responsible person if there is no authorized representative. This requirement was not met, evidenced by: the eviction notice was missing valid information and was improperly sent to C1's authorized representative. This is an immediate health and safety risk to clients in care.
8
9
10
11
12
13
14
Tuesday, March 22, 2022. Information which training agency was selected, the date of the training for the facility.
Type B
03/25/2022
Section Cited
CCR
80026(b)
1
2
3
4
5
6
7
Safeguards for Cash Resources, Personal Property, and Valuables of Residents. (b)...a client is accepted for or maintained in care, his/her cash resources, personal property and valuables...shall be handled by...
1
2
3
4
5
6
7
Training will be provided by CCLD vendorized agencies, that focus on personal rights. The training will be in conjunction with the eviction procedures. Must be submitted by 03/22//2022.
8
9
10
11
12
13
14
by the licensee or facility staff...This requirement was not met, evidenced by, LPA observed a video of C1's personal belongings wet in a trash bag. This is a potential health and safety risk to clients in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
03/07/2022 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20220307113017

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: 32DATE:
03/15/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gio Monico & Rod StinsonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not allow client to eat in the dining area
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced initial complaint visit, to discuss the allegations mentioned above. LPA was greeted by case manager Gio Monico, who was informed the reason of the visit. The Administrator Rod Stinson arrived shortly after but was not stay for the visit, but returned at the conclusion of the visit. The following was determined:

It was alleged staff did not allow client to eat in the dining area. LPA conducted interviews on 03/11/2022, 03/14/2022, 03/15/2022, from various times of the day, ranging from 8am to 4pm. It was revealed to LPA from interviews, the facility has different dining room hours throughout the day, for clients to eat and drink beverages. According to information obtained during the investigation, staff revealed that when dining hours are not open, clients are allowed to eat in there rooms or in common areas of the facility. The dining room would be
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20220307113017
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: 03/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
closed during set times, in order for staff to clean and prepare meals for clients. LPA was also informed by staff, that if a client request to eat in the dining room during the hours it is closed, they are allowed. LPA interviewed clients, who confirmed that statement. Therefore, based on interviews, the allegation, "Staff did not allow client to eat in the dining room", is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6