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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320310
Report Date: 11/25/2024
Date Signed: 11/25/2024 03:31:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2024 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20241120084931
FACILITY NAME:LONE STAR LONG BEACH ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198320310
ADMINISTRATOR:STINSON, RAHMIDFACILITY TYPE:
735
ADDRESS:6165 LINDEN AVETELEPHONE:
(818) 470-9185
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:6CENSUS: 4DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Case Manager, LaKesha JonesTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff do not provide a safe environment for residents in care
INVESTIGATION FINDINGS:
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On 11/25/24, Licensing Program Analyst, (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by Case Manager, LaKesha Jones and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:

On 11/25/24, Licensing Program Analyst (LPA) Shirley was met by staff, LaKesha Jones. LPA requested and received copies of the following: LIC 500, copies of resident file and a Special Incident report.

The investigation revealed the following:


Con’d on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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 11-AS-20241120084931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: LONE STAR LONG BEACH ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198320310
VISIT DATE: 11/25/2024
NARRATIVE
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Allegation: Staff do not provide a safe environment for residents in care

On 11/25/24, LPA Felisa Shirley arrived and toured this facility as a health and safety check. There are concerns of carbon monoxide poisoning due to the use of the stove for heating purposes. On 11/25/24 at 2:45am, per Special Incident Report, the EMT’s were called and came to this facility as there was a concern of carbon monoxide exposure. There was no alert from the carbon monoxide detector. The EMT’s conducted testing of exposure and the reading levels were zero. During facility tour, LPA checked the hallway heater to ensure that it works and learned that the pilot is not lit. Facility staff S-2 informed LPA that facility is equipped with a central air and heating unit instead and that air does not circulate evenly throughout the facility. There is a vent in every bedroom but the air does not circulate to the front of residence. Per S-2, staff sometimes bring portable heaters for warmth. The portable heaters have quick heating, timers and overheat protection systems and are monitored by staff and are inaccessible to clients to ensure protection of the clients’ safety.



LPA Shirley interviewed staff-1 thru staff-6 (S-1 thru S-6). LPA asked, does staff provide a safe environment for residents in care? Of those interviewed, 6 out of 6 answered yes. LPA interviewed Client-1 thru Client-4 (C-1 thru C-4). LPA asked, does staff provide a safe environment for residents in care?” Of those interviewed, 3 out of 4 answered yes, one client answered no. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff do not provide a safe environment for residents in care,” therefore the allegation is unsubstantiated.

There were no deficiencies cited during this visit.

LPA Shirley conducted an exit interview and a copy of this report was signed by staff LaKesha Jones.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2