455002494-8-15-2022-25-AS-MSEY-CHEM7F-20220818092124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002494
Report Date: 08/15/2022
Date Signed: 08/15/2022 01:00:22 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2022 and conducted by Evaluator Shannon Diegoruelas

COMPLAINT CONTROL NUMBER: 25-AS-20220504102120

FACILITY NAME:	STARLIGHT RESIDENTIAL		FACILITY NUMBER:	455002494
ADMINISTRATOR:	DECARLO, JAYME		FACILITY TYPE:	735
ADDRESS:	1861 CEDARWOOD DRIVE		TELEPHONE:	(530) 722-9476
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	5	CENSUS: 4	DATE:	08/15/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Mikko Ammon, Caregiver		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff hit resident with object.

INVESTIGATION FINDINGS:

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On 8/15/2022 Licensing Program Analyst (LPA) Shannon Diegoruelas arrived at the facility unannounced and met with Mikko Ammon to deliver complaint findings regarding the allegation that staff hit resident with object. Prior to visit LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted facility staff and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn; surgical Mask. Additionally, LPA was screened by facility staff at the front door.

During the course of the investigation, LPA conducted interviews with residents and staff. Interview with resident R1 indicated that they were hit by staff with a pine sol bottle. During the same interview, R1 indicated that they were hit with a water bottle instead of a pine sol bottle. R1 was interviewed on another date and indicated that staff were nice and respectful. Interviews revealed conflicting information. Interview with resident R2 indicated that they have not witnessed any staff hit R1. Interviews with staff S2, S3, and S7 indicated that they have not witnessed any staff members hit any residents in care. Interview with S6 also indicated that R1 has been known to make false statements.

Based on interviews conducted, LPA finds the allegation to be UNSUBSTANTIATED, a finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
No deficiencies were cited during today's visit. Exit interview was conducted and a copy of the report was provided to Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Shannon Diegoruelas
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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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