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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003810
Report Date: 10/18/2023
Date Signed: 10/18/2023 02:45:51 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2023 and conducted by Evaluator Kimberly Lyman
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231004114021
FACILITY NAME:STARLIGHT GUEST HOMEFACILITY NUMBER:
306003810
ADMINISTRATOR:CAROL ODULIOFACILITY TYPE:
735
ADDRESS:11232 LOARA STREETTELEPHONE:
(714) 537-8045
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 5DATE:
10/18/2023
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Hygeia "Gigi" BeyerTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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9
Resident is being physically abused by an unknown perpetrator
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed staff, clients, and witness as well as reviewed and obtained pertinent documentation such as facility notes and Individual Program Plan. Regarding the allegation that resident is being physically abused by an unknown perpetrator, the investigation revealed the following: Client 1 (C1) is diagnosed with Cerebral Palsy, Severe Intellectual Disability and non-verbal. C1 is ambulatory and always on the move. Client has an unsteady gait due to diagnosis. Facility staff indicate the client has a propensity to fall due to unsteady gait thus increasing chances for bruising. During the investigation, LPA observed client walking around the facility with an unsteady gait. Facility documentation indicates a fall resulting in bruising that occurred in June 2023. Five out of five clients, three out of three staff and one out of one witness deny any abuse in the facility. Due to conflicting information, LPA is unable to corroborate CONT ON LIC 9099C DATED 10/18/2023
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
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 22-AS-20231004114021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: STARLIGHT GUEST HOME
FACILITY NUMBER: 306003810
VISIT DATE: 10/18/2023
NARRATIVE
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Based on interviews conducted, the allegation is deemed to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did occur.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2