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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609683
Report Date: 06/08/2023
Date Signed: 06/08/2023 03:14:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
02/21/2023 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20230221135015
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: 28DATE:
06/08/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Gio Monico - Assistant AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility has insufficient food supply

Medications are unlocked and accessible to residents

Staff does not follow Medication Administration procedures
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to investigate the above allegations. LPA initially met with Assistant Administrator Giovany Monico and explained the reason for the visit.

LPA conducted physical plant tour at 12:38 PM, requested copies of facility documents relevant to the investigation at 1:04 PM and interviewed staff and residents between 1:10 PM to 3:00 PM. Regaring the allegation that the facility has insufficient food, It was alleged that there is not enough food at the facility. LPA's observation today at 12:38 PM and on prior visit on 03/01/23 at 10:00 AM revealed that there is sufficient food in stock both perishable and non-perishable in the facility's pantry, freezers and refrigerators. LPA's interview with staff today at 1:15 PM and on 03/01/23 between 10:45 AM to 1:00 PM revealed that there was no time that they were short of stock of food and if they were missing something, they called the administrator and immediately buy what they need. Further, they do grocery shopping every Friday for general food stock and produce twice a week. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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 3
Control Number 31-AS-20230221135015
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LONE STAR BOARD & CARE TUJUNGA
FACILITY NUMBER: 197609683
VISIT DATE: 06/08/2023
NARRATIVE
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(continued from LIC 9099)

LPA's interview with five (5) residents or more than 15% of current census today between 1:10 PM to 3:00 PM revealed that the food the facility serves is sufficient and they even have a midnight snacks.

Regarding the allegation that the Medications are unlocked and accessible to residents, it was alleged that the medication room/cabinet is unlocked. LPA's observation during today's visit at 12:45 PM and prior visit on 03/01/23 at around 10:00 AM revealed that during both visits, the medication room was locked and requested by the LPA to be opened and on both occasion, the medication cabinet was locked too. During today's visit, LPA observed the nurse giving medication to residents and arranging and organizing the medication room. LPA's interview with the facility Registered Nurse (RN) today also revealed that she was the one in charge of the medication room and medications of all the residents. LPA did not observe any medication outside of the medication cabinet except when the nurse was there distributing medications to residents.

Regarding the allegation that Staff does not follow Medication Administration procedures, it was alleged that the Facility staff does not follow medication administration policies and procedures, LPA's record review on 03/01/23 between 1:00 PM to 2:15 PM revealed that all the medication technicians are properly trained and LPA's interview with the facility nurse today revealed that the nurse conduct regular in service to the medication technician to remind, update and reinforce their knowledge of medication administration. Further interview with the nurse also revealed that she reviews the Medications Administration Records (MARs) whenever she comes to the office to make sure everything is in order.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3