197609683-10-6-2022-31-AS-MVAO-CKZSUP-20221109131129

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:39:11 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
10/21/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211021111535

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:	10/06/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Rod Stinson & Gio Monico		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident being bullied by staff

INVESTIGATION FINDINGS:

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Licensing Program Analyts (LPAs) Tuesday Cabiness and Tihesha Smith conducted a subsequent visit to deliver the final findings of the allegation mentioned above. LPA(s) met with Co-Aministrator Rod Stinson and Facility Manager Gio Monico, who were informed the reason of the visit. The following was determined:

It was alleged that resident being bullied by staff. On 10/22/2021 and 10/06/2022, from various times, ranging from 10am to 2pm, LPA conducted interviews with the complainant, other residents and facility staff. Information obtained through those interviews, revealed there were no witnesses to corroborate resident was bullied by staff. Although it was previously reported resident was being bullied by staff, during today's visit, interviews revealed, that there are no issues with staff or residents. Based on interviews, there is a lack of supportive evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

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.

LIC9099 (FAS) - (06/04)

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