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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601776
Report Date: 10/29/2021
Date Signed: 10/29/2021 05:50:45 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
07/08/2021 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210708134333
FACILITY NAME:LONE STAR BOARD & CAREFACILITY NUMBER:
198601776
ADMINISTRATOR:OTIS ALEXANDERFACILITY TYPE:
735
ADDRESS:5140 CRENSHAW BLVDTELEPHONE:
(562) 544-5170
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:35CENSUS: 19DATE:
10/29/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Direct Care Staff, Semaj “Leon” Floyd TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff intimidate resident
Staff are not administering correct medicine to residents
INVESTIGATION FINDINGS:
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On 10/29/2021 Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation at the above facility to address the following allegations. LPA Agard was met with Direct Care Staff, Semaj “Leon” Floyd and explained that the purpose of the visit was to gather information.

The investigation consisted of the following: LPA Agard toured the facility, and conducted interviews with staff, and clients.

On 10/29/2021 LPA Agard delivered findings.

Regarding the allegation: Staff intimidate resident. It’s being alleged that a client had an altercation with a staff in which the staff threw medication to the floor. The investigation revealed the following: 4 of the 5 clients interviewed state that they are not intimidated by staff. C1, who no longer resides at the facility,
Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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-20210708134333
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: LONE STAR BOARD & CARE
FACILITY NUMBER: 198601776
VISIT DATE: 10/29/2021
NARRATIVE
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states S6 is mean to them because they caught them doing something they were not supposed to be doing in the back of the facility. C1 refused to say what was observed and did not confirm the altercation happened. C2-5 all report not having any issues. C1 states “everyone is pretty nice.”

During Interviews with staff. 6 out of 6 denied the allegation to be true. S1 states, “no staff do not intimidate clients. That’s not tolerated.” S1 states, “C1 complained about many things but not S2 or S6. S6 denied the allegation to be true. “I never had a problem with C1. We barely had much interactions.”

Regarding the allegation: Staff are not administering correct medicine to residents. It’s being alleged that residents are not given the correct medication and told that if it isn’t available “'You won't die if you don't get it one day.” The investigation revealed the following: 4 out of the 5 clients denied having any issues with their medication or being given the wrong medication. C1 states their concern is there refills are coming in “the day the medication runs out. C1 states the fault goes to the pharmacy because of the cycle they are on. “That is all I need to get my thinking all screwed up.” C2-5 all report getting their medication timely and without error.

During Interviews with staff. 6 out of 6 could not confirm the allegation to be true. S1 states never hearing anything like that. “we do med inventory weekly. S2 states they give medication and there are no issues. “C1 will sometimes say a med is missing and the med that is missing is the one I’m administrating.” S2 denied ever telling any client: 'You won't die if you don't get it one day.” S6 denied ever having an altercation with C1 or throwing their medication.

Based on interviews, there was not enough evidence to support the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2