306005850-3-11-2022-22-AS-SSAS-CE9MK6-20220509094009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005850
Report Date: 03/11/2022
Date Signed: 03/11/2022 12:39:05 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
09/03/2021 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210903110953

FACILITY NAME:	COASTAL STAR CRISIS RESIDENTIAL CENTRAL		FACILITY NUMBER:	306005850
ADMINISTRATOR:	WEST, RYAN		FACILITY TYPE:	772
ADDRESS:	401 S. TUSTIN ST., BUILDING D		TELEPHONE:	(714) 289-3936
CITY:	ORANGE	STATE: CA	ZIP CODE:	92866
CAPACITY:	15	CENSUS: 12	DATE:	03/11/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Ryan West		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff spoke inappropriately to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Michelle Reed made an unannounced visit to the facility for the purpose of presenting the findings of the complaint investigation. Upon arrival, LPA met with Administrator Ryan West. The complaint was investigated by the Department and consisted of interviews with Staff, Administrator Ryan West, and witnesses as well as documentation. The following was determined:

Client #1 was admitted into the facility on 8/25/21. On 9/3/21 C1 told Staff #1 that he wanted to move out as the program is voluntary. S1 explained that C1 could not leave as there were protocols that needed to be followed first for discharge. C1 became upset as C1 wanted to leave right away. Staff completed discharge procedures and C1 left the facility on 9/3/21 at 11:11am. Based upon interviews and a review of records, the allegation is unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that an alleged violation occurred.

An exit interview was conducted with Ryan West and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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