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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602375
Report Date: 08/06/2025
Date Signed: 08/06/2025 02:35:56 PM

Substantiated


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
07/28/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250728131203
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: 3DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:administrator thana thengTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff does not ensure client's drinkware is free of mold.
INVESTIGATION FINDINGS:
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On 08/06/2025, 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 explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: LPA Calderon interviewed Administrator (S1), Staff (S2-S3), resident (R1-R3). 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) for R1.

The investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
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 5
Control Number 11-AS-20250728131203
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: 08/06/2025
NARRATIVE
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Regarding the Allegation: Staff do not ensure clients drinkware is free of mold.

This complaint alleged that R1 drinkware/water bottle had mold. LPA Calderon toured the facility and could not find any mold on drinking cups or water bottles. LPA Calderon inspected the facility and could not find any mold. Records review indicate the following: The Physician report indicate verbal resident with health issues. The Individual Service Plan indicates that R1 can communicate R1 needs and is not conserved. The facility’s annual report indicates that R1 is happy living at the facility and loves the day program. Interviews indicate the following: S1 indicates that there was mold on R1 water bottle and S1 takes full responsibility. 2 out of 3 staff deny the allegation that staff do not ensure clients drinkware is free of mold. R1 indicates that R1 had an old blue bottle that had mold. R1 states that staff will exchange a R1 blue bottle for a new bottle daily. 2 out of 3 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has been met therefore, the allegation of “staff does not ensure clients drinkware is free of mold” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D.

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

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 11-AS-20250728131203
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2025
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(2) To be accorded safe, healthful and comfortable accommodations....This was not met as evidence by:
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Administrator will provide aditional training to staff to check residents water bottles or change the residents water bottle for a new bottle daily, Administrator will email LPA Calderon with the updated training.
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Based on observations and interviews S1 indicates that R1 water bottle did have mold. This poses a potential health, safety to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
07/28/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250728131203

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: 3DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:administrator thana thengTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
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9
Staff handled client in an inappropriate manner resulting in injury.
INVESTIGATION FINDINGS:
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3
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5
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7
8
9
10
11
12
13
On 08/06/2025, 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 explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: LPA Calderon interviewed Administrator (S1), Staff (S2-S3), resident (R1-R3). 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) 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: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20250728131203
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: 08/06/2025
NARRATIVE
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Regarding the Allegation: Staff handled clients in an inappropriate manner resulting in injury.

This complaint alleged that staff handled the R1 ear inappropriately causing injury to R1 ear. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. Records review indicate the following: The Physician report indicate verbal resident with health issues. The Individual Service Plan (ISP) indicates that R1 can communicate R1 needs and is not conserved. The facility’s annual report indicates that R1 is happy living at the facility and loves the day program. R1 indicates that R1 left ear skin was dry and R1 scratched R1 ear. R1 states that no staff touched R1 ears. 2 out of 3 residents deny any the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff handled clients in an inappropriate manner resulting in injury” is found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5