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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603331
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:12:31 PM

Substantiated


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
12/09/2024 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241209121049
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: 57DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Jennifer Serrano - Acting AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not obtain permits to do construction on the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to determine the validity of the above-mentioned allegation. LPA met with Jennifer Serrano and Silvia Vidal, and explained the reason for the visit.

The investigation consisted of the following:
LPA obtained copies of the staff and resident rosters, copy of the Cirrection Notice (stop work order) issued from City of Bellfower, and photo copies of work being done to dining. LPA interviewed 2 Staff (S1&S2) and 6 Residents (R1-R6).

(continued on LIC9099-C)


Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 3
Control Number 28-AS-20241209121049
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: 12/12/2024
NARRATIVE
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The Investigation Revealed the Following:

Allegation: Staff did not obtain permits to do construction on the facility.
It is alleged that there is construction being done at facility and staff did not obtain proper permits for construction. LPA interviewed S1 & S2 and both confirmed that there was work done to repair a leak in the dining, as work was being done the city of bellflower code enforcement arrived and issued a stop work order, and advised staff to obtain the needed permits prior to continuing remodel. LPA obtained a copy of the Correction Notice dated 11/18/24 that indicated the Stop Work Order. LPA interviewed 6 residents and 6 out of 6 residents stated that the work being done in the dining did not affect them and that they are able to have meals in dining even with the remodel. LPA was never given prior notice for the work being done and the failure to report/ failure to submit an incident report of remodel will be cited in a Case Management visit today.

Based on LPAs observations and interviews which were, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview held, and a copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241209121049
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
87305(a)
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87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit.
This standard was not met as evidence by:
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Licensee/Administrator to email LPA a copy of permits/apporoval by POC due date along with any updates/paperwork from City of Bellflower regarding the remodel to dining area.
tena.herrera@dss.ca.gov
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During interviews with S1 and S2 both confirmed that construction had begun to dining area and was stopped as City of Bellflower Code Enforcement arrived on 11/18/24 at 10:45am with a Stop Work Order and informed facility staff that all necessary approvals/permits must be obtained prior to continuing remodel in dining.
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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.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3