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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:41:40 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
10/14/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20211014161322
FACILITY NAME:LONE STAR BOARD & CARE TUJUNGAFACILITY NUMBER:
197609683
ADMINISTRATOR:ALEXANDER, OTISFACILITY TYPE:
735
ADDRESS:10117 TUJUNGA CANYON BLVDTELEPHONE:
(562) 544-5170
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:35CENSUS: 26DATE:
10/06/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rod Stinson & Gio MonicoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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1. Facility staff did not prevent residents from engaging in physical altercations
2. Facility staff did not prevent residents from engaging in verbal altercations
3. Facility staff did not safeguard resident's personal property
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:

Allegation # 1: Facility staff did not prevent residents from engaging in physical altercation. On 10/22/2021 from 10am to 145pm, LPA received facility documents and interviewed residents and facility staff. Information obtained revealed, that client #1 (C1) alleged client # 2 (C2) grabbed C1's hand, causing a nail to break. Interviews conducted revealed there were no witnesses to the alleged incident; but it was confirmed from facility staff there was tension and issues between C1 and C2. During today's visit, from 2pm to 3pm, it was reported to LPA(s) that both clients are no longer residing at the facility, therefore, LPAs were not able to interview C1 and C2 regarding the alleged incident. Also, LPA attempted several times to reach the complainant, but was unsuccessful. Therefore, based on interviews and documentation, the allegation is deemed 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)
Page: 1 of 2
Control Number 31-AS-20211014161322
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: 10/06/2022
NARRATIVE
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Allegation # 2: Facility staff did not prevent residents from engaging in verbal altercations. On 10/22/2021 from 10am to 145pm, LPA received facility documents and interviewed residents and facility staff. Information obtained revealed, that client #1 (C1) alleges client # 2 (C2) verbally abuses C1. Interviews conducted revealed there were no witnesses to the alleged verbal abuse, and C1 never reported incidents to staff. Although it was confirmed from facility staff there was tension and issues between C1 and C2, there was no observations by staff of verbal abuse. During today's visit, from 230pm to 345pm, it was reported to LPA(s) that both clients are no longer residing at the facility, therefore, LPAs were not able to interview them regarding the allegation. LPA attempted several times to reach the complainant, but was unsuccessful. Therefore, based on interviews and documentation, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation # 3: Facility staff did not safeguard resident's personal property. On 10/22/2021 from 10am to 145pm, LPA received facility documents and interviewed facility staff. According to the information obtained during that visit, C1 left the facility in October 2021, and did not return until December 2021. When C1 returned to the facility, C1 packed up all personal belongings and relocated to another facility in Los Angeles. During today's visit, from 230pm to 345pm, it was reported to LPA(s) that C1 no longer resides at the facility and has not been back since December 2021. LPA attempted several times to reach the complainant, but was unsuccessful. Therefore, based on interviews, the allegation is UNSUBSTANTIATED at this time.
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
LIC9099 (FAS) - (06/04)
Page: 2 of 2