197609683-12-7-2022-31-AS-TCAS-CLVQBV-20221207110212

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609683
Report Date: 12/07/2022
Date Signed: 12/07/2022 11:02:35 AM

Document Has Been Signed on 12/07/2022 11:02 AM - 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 TUJUNGA		FACILITY NUMBER:	197609683
ADMINISTRATOR:	ALEXANDER, OTIS		FACILITY TYPE:	735
ADDRESS:	10117 TUJUNGA CANYON BLVD		TELEPHONE:	(818) 875-4501
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY: 35		CENSUS: 26	DATE:	12/07/2022
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Otis Alexander, Rod Stinson, Gio Monico		TIME COMPLETED:	11:35 AM

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	An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional Office. The purpose of this Informal Conference is to discuss recent deficiencies, and numerous Unsubstantiated and Substantiated complaints, ranging from dealing with allegations of staff misconduct, and the treatment of clients. Prior to the meeting, Administrator/Licensee Otis Alexander, Co-Administrator Rod Stinson, and Case Manager Gio Monico was given the chance to review the facility file. Present at today's meeting are the following: · Otis Alexander - Administrator/Licensee Co-Administrator – Rod Stinson Case Manager – Gio Monico · Cassandra Harris, Licensing Program Manager (LPM) – Woodland Hills South RO · Tuesday Cabiness, Licensing Program Analyst (LPA) – Woodland Hills South RO Ulysses Coronel – Licensing Program Manager – El Segundo RO Troy Agard – Licensing Program Analyst (LPA) – El Segundo RO Benita Yates – Regional Manager – El Segundo RO The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department's Legal Division for possible license revocation or other administrative actions. BRIEF HISTORY: Facility has been in operation since licensure on December 03, 2018, for a maximum of five (35) clients.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: 12/07/2022

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

LPM Harris discussed and expressed concerns regarding the following concerns pertaining to the following: On June 22, 2022, a complaint investigation was conducted by LPA Tuesday Cabiness regarding the allegation “Staff did not administer medication to client as prescribed”. Based on the investigation it was revealed that C1 was not being administered medication for (3) months, beginning in the month of December 2021, January 2022 and February 2022. LPA obtained information from the pharmacy, that C1's medication was not ordered or delivered to the facility for C1, because facility staff did not contact the appropriate representatives to ensure that C1's medication was continued and ordered. It was also revealed that facility staff was initializing on the medication administration record (MAR) that C1 was given medication as prescribed, when C1 was not. LPA also reviewed other client medication records, and it was observed, that client # 2 (C2) was not giving medication as prescribed, and staff documented that C2 was given medication.

On March 15, 2022, LPA Tuesday Cabiness a conducted a case management in conjunction with the complaint investigation to address issues related to the complaint (control #: 31-AS-20220307113017). During the investigation, it was revealed to LPA that the facility did not submit (4) incident reports relating to client # 1 (C1), who was issued an eviction notice for various incidents at the facility. According to staff, there was no explanation as to why the incident reports were not submitted to Licensing. Also, a Substantiated complaint was issued, for an Unlawful Eviction and failure to safeguard resident's belongings.

On April 24, 2021, LPA Yelena Avetisyan conducted a case management with deficiencies, regarding facility not obtaining a medical assessment; TB test, Mental Health intake assessment, PRN authorization letter, and staff not completing the centrally stored medication and destruction records correctly. Also, it was revealed that the facility did not practice counting medication for new admits.

On January 30, 2020, LPA Patrick Shanahan, substantiated a complaint and issued citations for the allegation male resident displayed inappropriate sexual behavior in front of other residents. Facility staff was able to redirect the resident (R1) and staff was alerted to make more visual checks on the R1 while the R1 is in the common areas.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 12/07/2022

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

The resident's case worker was immediately notified and R1 was issued a (30) day eviction notice. R1 had already been relocated prior to the LPA's visit.

LPM would also like to address the numerous complaints pertaining to staff, and there conduct with residents.

WH Regional Office is offering and suggesting to Licensee for the following options provided:
· Technical Support Program (TSP) offered by the Department -- Administrator accepted, LPA will submit the application for all (3) offices:
· Reach out to your Housing for Help Contract with DHS for further staff training
· Updated and submit current LIC500 Personnel Report

Administrator and Case Manager reported the facility has hired a Registered Nurse (RN) who provides medication management and monitors the health of clients. Facility also has hired a new pharmacy, that conducts monthly audits, as well as Department of Health Services conduct medication audit for clients.

The Licensee was informed that Community Care Licensing (CCL) shall continue to monitor the facility with annual facility inspection visits and as often as necessary to ensure the Licensee's compliance with Title 22 Regulations. The Licensee was also informed that there is (1) pending complaint and any further citations and/or non-compliance may result in a Non-Compliance Conference with the Regional Manager.

Exit interview conducted and copy of today's report was provided to the Licensee.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3