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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602375
Report Date: 07/18/2022
Date Signed: 07/18/2022 07:24:09 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
07/11/2022 and conducted by Evaluator Don Senaha
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220711142336
FACILITY NAME:ROSTAR HOME II INCFACILITY NUMBER:
198602375
ADMINISTRATOR:THENG, THANAFACILITY TYPE:
735
ADDRESS:1527 WEST 247TH PLACETELEPHONE:
(310) 326-1746
CITY:HARBOR CITYSTATE: CAZIP CODE:
90710
CAPACITY:4CENSUS: 4DATE:
07/18/2022
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Licensee - Thana ThengTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff hit resident
Staff made inappropriate comments towards resident
INVESTIGATION FINDINGS:
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On 07/18/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegations listed above.

Today’s complaint investigation was conducted with Licensee Thana Theng. The investigation consisted of the following: LPA requested and received resident roster, staff roster and other service documents on 07/18/2022. LPA interviewed staff (S1-S2), client (C1-C3) and witness (W1). Client (C4) was not available during the investigation visit.

A plant inspection of the facility was conducted on 07/18/2022. No deficiencies were found at the time of the visit.

Investigation revealed:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
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 11-AS-20220711142336
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: ROSTAR HOME II INC
FACILITY NUMBER: 198602375
VISIT DATE: 07/18/2022
NARRATIVE
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Allegation: Staff hit resident.

During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above.

There is no evidence that supports staff hit residents. Clients (C2-C3) stated they have not been hit or slapped by staff. Staff (S1-S2) stated clients have not been hit or slapped by staff. Witness (W1) from Harbor Regional Center stated all four clients (C1-C4) has not been hit or slapped by staff. Witness (W1) has not seen any type of abuse taking place at the facility. LPA interviewed staff (S1-S2) who stated there are neighbors who have concerns about some temporary noise like banging on the walls and yelling. Staff (S1-S2) stated there is kicking, banging of the walls and yelling from client (C1) due to behavior issues.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. 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 Unsubstantiated

Allegation: Staff made inappropriate comments towards resident

During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above.

There is no evidence that supports staff has made inappropriate comments towards resident/client. LPA interviewed clients (C2-C3) who stated staff does not yell or make inappropriate comments towards any clients. Staff (S1-S2) stated staff do not yell or make inappropriate comments towards clients. Witness (W1) stated (W1) has not seen or heard staff yell at the clients. Witness (W1) stated (W1) has not seen or had any reports of any inappropriate comments made towards clients.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation 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 allegation is Unsubstantiated

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2