198602375-4-16-2025-11-AS-UCOL-DGPMB4-20250515092720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602375
Report Date: 04/16/2025
Date Signed: 04/16/2025 02:41:39 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
04/08/2025 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20250408121942

FACILITY NAME:	ROSTAR HOME II INC		FACILITY NUMBER:	198602375
ADMINISTRATOR:	THENG, THANA		FACILITY TYPE:	735
ADDRESS:	1527 WEST 247TH PLACE		TELEPHONE:	(310) 326-1746
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	4	CENSUS: 3	DATE:	04/16/2025
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	ADMINISTRATOR THANA THENG		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff pulled resident's ear
Staff does not treat resident with respect

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 04/16/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Rostar Home 2 Facility and was greeted by Administrator Thana Theng (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the finding pertaining to the above-mentioned allegations.
The investigation consisted of the following: LPA Calderon interviewed Administrator (S1), Staff (S2-S3), resident (R1-R3), witness (W1). LPA Calderon obtained the following records: Physician report (dated 06/17/2024), Individual Service Plan (ISP) (dated 12/19/2024), Facility Annual report (dated 10/26/2023), Incident report (dated 04/02/2025) for R1.
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

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-20250408121942

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: ROSTAR HOME II INC	FACILITY NUMBER: 198602375
	VISIT DATE: 04/16/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the Allegation: Staff pulled resident’s ear.

This complaint alleged that staff pulled R1 ear and R1 ear was injured. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. Records review indicate the following: Physician report indicate verbal resident with health issues. Individual Service Plan (ISP) indicates that R1 can communicate R1 needs and is not conserved. Facility annual report indicates that R1 is happy living at the facility and loves the day program. Incident report indicates that on 04/02/2025 R1 family member asked staff member to cut R1 hair and when staff member was cutting R1 hair R1 moved R1 head and R1 ear was cut. R1 was not taken to the hospital and antibiotic was used. Interviews indicate the following: 3 out of 3 staff deny pulling R1 ear. W1 indicates that R1 advised W1 that staff had pulled R1 ear for unknown reasons. W1 indicates that W1 did ask staff to cut R1 hair. R1 indicates that R1 does not remember the date of the incident but that staff pulled R1 ear and injured R1 ear. R1 indicates that R1 ear has healed. 2 out of 3 residents deny any staff member pulling R1 ear. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff pulled residents ear” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff do not treat resident with respect.

This complaint alleged that staff yelled and called R1 names for unknown reason. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. Records review indicate the following: Physician report indicate verbal resident with health issues. Individual Service Plan indicates that R1 can communicate R1 needs and is not conserved. Facility annual report indicates that R1 is happy living at the facility and loves the day program. Interviews indicate the following: 3 out of 3 staff deny the allegation that staff do not treat R1 with respect. W1 indicates that R1 advised W1 that staff had yelled at R1 and called R1 names for unknown reasons. R1 indicates that all staff treat R1 with respect. 2 out of 3 residents indicate that all staff treat them with respect. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff does not treat resident with respect” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report were provided to the Administrator Thana Theng (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2