198601102-11-5-2021-11-AS-UCOL-CG83LE-20220710182034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601102
Report Date: 11/03/2021
Date Signed: 11/05/2021 08:05:53 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2021 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211028093056

FACILITY NAME:	S.T.A.R., INC.		FACILITY NUMBER:	198601102
ADMINISTRATOR:	BRODERICK, PAMELA		FACILITY TYPE:	735
ADDRESS:	4226 WEST 231ST STREET		TELEPHONE:	(310) 791-3333
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	6	CENSUS: 6	DATE:	11/03/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Pamela Broderick and Porche Milner		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not prevent client from choking

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, November 03, 2021. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met House Manager Porche Milner with LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed four staff 1-4 (S1-4) and two clients 2-3 (C2-3). Allegation: Staff did not prevent the client from choking. Staff stated C1 was at the above facility because his Star House III #198602198 located at 5020 MaCaffe Road, Torrance, CA 90505 an all boy's home was being cleaned. Staff stated C1 does require one-on-one care. C1 client was given an El Pollo Loco chicken bowl, not a chicken salad with a hard shell taco. Staff and clients interviewed stated C1 was not choking on his food. The clients can eat their food without choking. Staff would have reported a choking incident if the allegation was true.
See continued LIC9099-C page #2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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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Control Number 11-AS-20211028093056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: S.T.A.R., INC.	FACILITY NUMBER: 198601102
	VISIT DATE: 11/03/2021

NARRATIVE

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Continued LIC9099-C page #2

Investigation revealed the following: The incident involved the client choking. S1-4 and C2-3 stated that they never observed C1 choking on a chicken salad with a hard shell taco. Staff stated C1 was eating an El Pollo Loco chicken bowl. Clients interviewed stated that they are happy at the facility and staff are providing clients with excellent care and supervision. Staff stated Harbor Regional Center approved one on one care for the C1 for 90 days through a staffing agency which the facility previously used for one on one care for the C1 through Kaiser Permanente. On 10/27/2021, the staffing agency employee sat the C1 at the table, placed his lunch in front of him, and proceeded to walk to the couch to use his cell phone. Two of the STAR staff members were trading off on assisting C1 until they were called to work with the other clients present. STAR staff issued a directive to the staffing agency member to assist the C1 with finishing his meal, which the staffing agency member seemed to take issue with. C1 started to cough, as he routinely does while eating, drawing the attention of STAR staff. The staffing agency employee then approached the C1 and appeared to attempt to assist the client with dislodging the food. Staff stated It is unclear whether this was a necessary action. C1 was not choking, he was fine and did not need to go to the hospital. Staff and clients denied allegations and stated it was false.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

LPA Bunker provided Executive Director Pamela Broderick with copies of LIC9099, LIC9099-C, and LIC811.

There were no deficiencies cited.

Exit interview conducted

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC9099 (FAS) - (06/04)

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