374603625-9-28-2023-08-AS-LTEZ-CWZT9D-20231027143146

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603625
Report Date: 09/28/2023
Date Signed: 09/28/2023 07:41:33 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, 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
09/22/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20230922092654

FACILITY NAME:	STELLAR CARE		FACILITY NUMBER:	374603625
ADMINISTRATOR:	LINDA CHO		FACILITY TYPE:	740
ADDRESS:	4518 54TH STREET		TELEPHONE:	(619) 287-2920
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	120	CENSUS: 80	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Resident Service Coordinator, Mai Truong		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Lack of supervision resulted in inappropriate behavior

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted a complaint investigation regarding the above-mentioned allegation. LPA met with Assistant Administrator, Brandon Cho and Resident Services Coordinator, Mai Truong.

During today’s visit, LPA briefly toured the facility, requested records, and interviewed staff and residents. It was alleged that lack of supervision resulted in inappropriate behavior. The facility’s population are residents that have a diagnosis of Major Neurocognitive Disorder. It was reported Resident #1 (R1) and Resident #2 (R2) had an inappropriate interaction, the date and time are unknown. R1 has a bathroom located in their bedroom but it’s been inoperable for months. Facility staff interviews revealed R1 has a history of throwing items in the toilet causing it to clog. Therefore, the facility installed a lock on R1’s bathroom door that requires a code, which R1 does not have access to. R1 is made to use the public bathroom down the hall. It was also reported due to R1 having to use the bathroom down the hall, the apartment door was left open for R2 to enter. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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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Control Number 08-AS-20230922092654

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: STELLAR CARE	FACILITY NUMBER: 374603625
	VISIT DATE: 09/28/2023

NARRATIVE

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Interviews revealed R2 entered R1’s bedroom and got into bed with R1, which was not welcomed. Staff interviews indicated all resident apartment doors automatically lock and all residents are supplied with their own key. Additional staff interviews revealed they have not witnessed R2 enter R1’s room or made aware of the incident. Resident interviews confirmed the apartment doors lock automatically.

During the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Resident Service Coordinator, Mai Truong whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC9099 (FAS) - (06/04)

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