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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802273
Report Date: 09/01/2023
Date Signed: 09/01/2023 02:30:05 PM

Document Has Been Signed on 09/01/2023 02:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:STARLING HOMEFACILITY NUMBER:
405802273
ADMINISTRATOR:DEBORAH STARLINGFACILITY TYPE:
735
ADDRESS:872 SYCAMORE CANYON RDTELEPHONE:
(805) 237-7307
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 5DATE:
09/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Administrator / Deborah StarlingTIME COMPLETED:
10:58 AM
NARRATIVE
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 At 8:00am on 09/01/2023, Licensing Program Analyst (LPA) Jeffries and Tri Counties Regional Center (TCRC), Quality Assurance Specialist, Miguel Magana (QA), arrived at the facility. This was a scheduled meeting initiated by QA of TCRC in regard to a report that TCRC received. Administrator Deborah Starling, QA, and LPA were in attendance. This case management visit is addressing several (four) allegations of staff being verbally abusive to clients in care, which is a personal rights violations. On 08/28/2023, TCRC received a report from a creditable witness that Staff 1 (S1) has been using foul language, raising their voice, using the phone while driving, and throwing an adult diaper at Resident 1 (R1). Additionally, there have been three other, different and independent sources from two different CCLD program facilities documenting and reporting to CCLD of facility staff inappropriately talking to facility clients. This current report being addressed today is also a different and independent source of the other three reporting sources. Prior to this report a complaint was investigated (29-AS-20230607145156) and the specific incident to the compliant was deemed unsubstantiated, However during the investigation of that complaint, it was discovered in interviews of facility staff on 06/13/2023, that S1 had witnessed, S2 talking "brutally" to clients in care at the facility and forcing by verbal threat for clients to stay upstairs in their rooms, which resulted in a case management visit and a technical violation of personal rights on 08/04/2023. TCRC and CCLD are concerned that the multiple reports by separate and independent sources hold enough weight to warrant immediate intervention. Administrator, QA, and LPA discussed the aforementioned reports during this meeting. Based on the total of 4 reports of staff verbally abusing clients, interviews of staff on 06/13/2023, and the creditable witness reporting of TCRC's report. the facility will be accessed a citation at this time.

Exit interview, report read, report signed, appeal rights and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/01/2023 02:30 PM - It Cannot Be Edited


Created By: Mark Jeffries On 08/30/2023 at 09:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: STARLING HOME
FACILITY NUMBER: 405802273

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2023
Section Cited
CCR
80072(a)(1)

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80072 Personal Rights (a)Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met by
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Administrator agreed to provide staff training of Person Centered Thinking Training, provided by TCRC for all staff. And 1 one hour of medication training, by TCRC for all staff. To be complated by September 22, 2023.
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evidence of 4 independent reports of staff verbal abuse, interviews and creditable witnesses, which poses potential danger to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kelly Burley
LICENSING EVALUATOR NAME:Mark Jeffries
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023


LIC809 (FAS) - (06/04)
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