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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609683
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:33:48 PM

Document Has Been Signed on 10/06/2022 03:33 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: 26DATE:
10/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rod Stinson & Gio MonicoTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Tuesday Cabiness and Tihesha Smith conducted a case management, pertaining to an special incident report (SIR) sent to Licensing alleging client #2 (C2) inappropriately touched client #1 (C1). During today's visit, LPA conducted interviews with facility staff and C2. At the time of the visit, C1 was not at the facility and was visiting family.

Information and interviews conducted, revealed that C2 denied touching C1. LAPD came to the facility and conducted interviews with C1 and C2. Based on there information, there was inconsistencies statements made by C1, therefore there was no arrest or report taken regarding the incident. C2 denied the allegation to LPA(s), and LPA(s) were not able to interview C1. At this time, LPA(s) will follow up with the facility to obtain contact information for C1 and further information is needed at this time.

Exit interview and copy of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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