374602372-10-26-2021-08-AS-SJAB-C89RQH-20211029131334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602372
Report Date: 10/26/2021
Date Signed: 10/26/2021 03:08:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/12/2019 and conducted by Evaluator Laarni Santiago

COMPLAINT CONTROL NUMBER: 08-AS-20191112155149

FACILITY NAME:	STAR RESIDENTIAL		FACILITY NUMBER:	374602372
ADMINISTRATOR:	ALBERT SOUZA		FACILITY TYPE:	740
ADDRESS:	4469 ROBBINS STREET		TELEPHONE:	(858) 622-1933
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92122
CAPACITY:	6	CENSUS: 6	DATE:	10/26/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Albert Souza, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility staff slaps residents
Facility staff handled resident in a rough manner resulting in bruising

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Laarni Santiago conducted an unannounced visit to render finding on the above listed complaint allegations. LPA was granted entry into the facility and met with Albert Souza, Administrator, to whom she explained the reason for the visit.

Community Care Licensing (CCL) has investigated the above listed allegations. The investigation consisted of a tour of the facility, review of facility records, and interview of outside sources and facility staff.

It was alleged that facility staff slaps residents on the cheek to wake them up if they fell asleep at the dining room table. Outside source reported that they allegedly observed facility staff tap the resident on their cheek to wake them up and there is another unidentified staff that observed this occurrence. However, interviews conducted with staff refuted the claim that this allegation occurred. Interviews conducted with multiple sources denied observing any of the staff hit, tap or slap any of the residents on

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni Santiago	TELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

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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Control Number 08-AS-20191112155149

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: STAR RESIDENTIAL	FACILITY NUMBER: 374602372
	VISIT DATE: 10/26/2021

NARRATIVE

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their cheek. Furthermore, outside source and relevant persons did not express any concerns regarding staff treatment towards residents. Resident 1’s (R1) home health stated that if there were any physical evidence that R1 was hit in the face, a bruise would’ve appeared due to the nature of their fragile skin and the medication that makes their skin prone to bruising. There were no other relevant witnesses or physical evidence to corroborate that this type of abuse occurred at the facility. LPA was unable to interview residents as majority have expired during the course of the investigation.

It was also alleged that staff had aggressively handled R1 that resulted in their bruising on their body. Licensees shall ensure that all residents are free from all types of abuse – including physical. In interviews conducted with multiple sources, it was revealed that the resident was observed to have had bruises. There were concerns that the bruising may have occurred from staff members at the facility handling the resident in a rough manner when transferring or repositioning them. Outside source made a statement that it was reported to them that R1 was hit by staff, however, they did not observe this incident firsthand. Interviews conducted with multiple sources revealed that they had not ever heard of or seen any staff members handling the resident in a rough manner during changes, transferring or repositioning. Outside sources confirmed the presence of the bruises but stated verbally that there were no immediate concerns that the bruises were the result of staff being intentionally rough with the resident. The resident’s home health had indicated that the resident is taking medications that make them more prone to bruising. Furthermore, records revealed that R1 has a medical condition which made them more susceptible to bruising.

Based on interviews and record review, the above-mentioned allegations are deemed Unsubstantiated. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. An exit interview was conducted with Administrator and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Licensee via electronic mail. An electronic read receipt confirmation was requested to be sent by the Licensee upon receipt of the documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni Santiago	TELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

LIC9099 (FAS) - (06/04)

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