405802273-11-2-2022-29-AS-KBUY-CQCM4M-20230328091658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405802273
Report Date: 11/02/2022
Date Signed: 11/02/2022 05:22:51 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20221101162949

FACILITY NAME:	STARLING HOME		FACILITY NUMBER:	405802273
ADMINISTRATOR:	DEBORAH STARLING		FACILITY TYPE:	735
ADDRESS:	872 SYCAMORE CANYON RD		TELEPHONE:	(805) 237-7307
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	6	CENSUS: 6	DATE:	11/02/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Debbie Starling, Licensee/Administrator		TIME COMPLETED:	05:35 PM

ALLEGATION(S):

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Staff yelled at residents in care
Staff does not treat residents with dignity or respect

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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 4

Control Number 29-AS-20221101162949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: STARLING HOME	FACILITY NUMBER: 405802273
	VISIT DATE: 11/02/2022

NARRATIVE

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On 10/20/22 and 10/21/22, starting at 12:26 pm, LPA interviewed residents and witnesses. Witnesses say they have received comments from residents who say they are agitated towards S1 because S1 “pushes residents to do things,” and that “S1 is rude and irritates” them. Witnesses say they observed S1 get upset with a resident and use an “aggressive, high volume, high tone of voice” and “commanded” residents. Witnesses say the resident was visibly shaken. Residents interviewed say that S1 yells at everybody, is pushy and demanding, and uses profanity in the facility and that this has been going on for a long time.

Based on the evidence obtained, the allegations, “Staff yelled at residents in care” and “Staff does not treat residents with dignity or respect,” are deemed Substantiated at this time. Interviews reveal that S1 has been verbally aggressive and disrespectful to residents in care. Deficiency cited on a 9099-D page.

Exit interview conducted, deficiency cited, and the report and appeal rights emailed to the licensee.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20221101162949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: STARLING HOME	FACILITY NUMBER: 405802273
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/02/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/03/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1(a)(1) Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will have a three-way conversation with licensee, S1 and Resident #1. Licensee will provide training on working with individuals with behavioral issues. Licensee will counsel S1 on treating residents with dignity and respect and review regulation cited. Licensee has committed to have the three-way conversation by 11/5/22 and email LPA regarding the details/notes of the conversation. Licensee will send CCL the training sign-in sheet, signed by staff by 11/5/22. Licensee will send CCL the signed and dated counseling report by end of day 11/3/22.
	8 9 10 11 12 13 14	Staff #1 did not treat residents with dignity and respect by yelling at and intimidating them. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20221101162949

FACILITY NAME:	STARLING HOME		FACILITY NUMBER:	405802273
ADMINISTRATOR:	DEBORAH STARLING		FACILITY TYPE:	735
ADDRESS:	872 SYCAMORE CANYON RD		TELEPHONE:	(805) 237-7307
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	6	CENSUS: 6	DATE:	11/02/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Debbie Starling, Licensee/Administrator		TIME COMPLETED:	05:35 PM

ALLEGATION(S):

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Staff inappropriately disciplined residents in care

INVESTIGATION FINDINGS:

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On 11/2/22 at 3:30 pm, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced initial 10-day complaint investigation visit to the facility listed above. LPA met with Debbie Starling, Licensee/Administrator, and explained the purpose of the visit.

On the allegation, “Staff inappropriately disciplined residents in care,” the complainant’s concern was that S1 will withhold care from residents, if S1 gets angry. Further, complainant was concerned that S1 punishes residents if they are running. To investigate, LPA interviewed residents and witnesses.

During LPA’s interviews on 10/20/22 and 10/21/22 with residents and witnesses, LPA found that interviews did not indicate that S1 was withholding care from residents nor that S1 punishes residents. Based on the evidence obtained, the allegation “Staff inappropriately disciplined residents in care,” is deemed Unsubstantiated at this time.

Exit interview conducted and the report emailed to the licensee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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

LIC9099 (FAS) - (06/04)

Page: 4 of 4