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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603331
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:34:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2022 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221107154151
FACILITY NAME:BRIGHT STAR ASSISTED LIVINGFACILITY NUMBER:
198603331
ADMINISTRATOR:MARQUEZ, JOSE MFACILITY TYPE:
740
ADDRESS:9349 ROSE STREETTELEPHONE:
(818) 642-3668
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:70CENSUS: 50DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Louie Mascardo - AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Unlawful Eviction.
Staff not providing adequate service to resident in care.
Resident left in soiled diapers for extended amount of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Louie Mascardo (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of the resident and staff rosters and interviewed Administrator, Staff 1 - Staff 2 (S1 - S2) and Resident 1 - Resident 5 (R1 - R5). Copies of R1's eviction notice, rent receipts, diapers delivery receipt, physician report, appraisal/needs and services plan, admission agreement, preplacement appraisal information, functional capability assessment and behavior notes.

The investigation revealed the following: regarding the allegation "unlawful eviction", it is alleged that R1 was asked to sign a blank piece of paper and was later told that this was an eviction notice because R1 is late in rent and R1 states that is not true and was not given a copy of the notice. (CONTINUED TO LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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 28-AS-20221107154151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BRIGHT STAR ASSISTED LIVING
FACILITY NUMBER: 198603331
VISIT DATE: 11/16/2022
NARRATIVE
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Interview conducted with administrator revealed that R1 has not paid the full rent for multiple months ($1,200 monthly) and has accumulated a balance of $2,355. Administrator denied giving the resident a blank piece of paper to sign and that a copy of the eviction notice was given to R1 the day that it was served which is 10/18/22. Interview conducted with S2 revealed that S2 saw that the eviction notice and it was not blank when it was served to R1 and that a copy was given to R1. Interview conducted with R1 revealed that it is true that R1 is late with rent but she was never given a copy of the eviction notice. Reviewed of R1's rent receipts shows that R1 did not paid rent in full for the following months: July, September, and October of 2022. Reviewed of the eviction notice shows that R1 signed it on 10/18/22 and it is a lawful eviction per Title 22 Section Code 87224.

Regarding the allegation "staff not providing adequate service to resident in care", it is alleged that S1 does not speak English and it is very hard to communicate with S1 when things are needed. Administrator and staff interviewed denied the allegation and stated that S1 does speak English with a slight accent. Residents interviewed could not corroborate the allegation. LPA spoke to S1 and confirmed that S1 does speak English.
Regarding the allegation "resident left in soiled diapers for extended amount of time", it is alleged that R1 was left in soiled diapers on 11/06/2022 and 11/07/2022 and had asked the staff to be changed, but staff told R1 that the administrator told them to stop providing supplies such as diapers and wipes to R1 for an unknown reason. Administrator and staff interviewed denied the allegation and stated that R1 receives 2 boxes of 48 diapers monthly and are placed in the resident's room. They also stated that the R1 still had diapers on those day and that the R1 does not need assistance with changing the diaper. Residents interviewed could not corroborate the allegation and stated that facility always provides diapers and wipes to them. Interview with R1 revealed that R1 does not need assistance with changing diapers, but on 11/06/22 and 11/07/2022 R1 ran out of diapers and staff refused to provide more. LPA observed a pack of diapers in R1's room and asked R1 when did she received this pack and R1 just stated a while ago. Reviewed of R1's physician report, appraisal/needs and services plan, admission agreement, preplacement appraisal information, functional capability assessment and behavior notes revealed that the R1 does not need assistance with changing diapers.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
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