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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425567
Report Date: 09/11/2023
Date Signed: 09/11/2023 11:16:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2020 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20200512112907
FACILITY NAME:RISING STAR CARE HOMEFACILITY NUMBER:
336425567
ADMINISTRATOR:JAMES REEDFACILITY TYPE:
740
ADDRESS:30045 AUDELO STREETTELEPHONE:
(951) 609-3300
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:0CENSUS: 0DATE:
09/11/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:James Reed, LicenseeTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Staff does not provide a safe environment for resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/11/2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an office visit with James Reed at the Riverside Adult and Senior Care Regional Office, to deliver findings to the allegation mentioned above. During the investigation, Staff, Resident’s sister and Kaiser Medical Social Worker were interviewed.
Regarding the allegation “Staff does not provide a safe environment for resident”, it was alleged that that licensee had verbal argument with resident and threw mail at resident. Licensee was interviewed who denied had verbal argument with resident and threw mail at resident. Licensee stated resident was being aggressive to caregivers, 911 was called and resident was taken to hospital. Licensee stated resident never returned to the facility after being taken to hospital. LPA couldn’t locate resident for an interview. Kaiser Medical Social Worker was interviewed who reported resident was brought in for a psych hold and was later discharged to another room and board. Kaiser Medical social worker further reported resident passed away in 12/2021. Resident’s sister was interviewed who reported resident passed away years ago. LPA was unable to interview resident to determine if Licensee has verbal argument with resident and threw mail at resident.
Based on interviews with staff, Resident’s sister and Kaiser Medical Social Worker, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to James Reed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
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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