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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002707
Report Date: 03/01/2023
Date Signed: 03/01/2023 11:41:29 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2022 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20221205134655
FACILITY NAME:STARLIGHT RESIDENTIAL 2FACILITY NUMBER:
455002707
ADMINISTRATOR:WHITESIDE, MICHAELFACILITY TYPE:
735
ADDRESS:2850 SHASTA STTELEPHONE:
(530) 276-0129
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:4CENSUS: 3DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Rachelle Whiteside - licenseeTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Licensee restrained client. - UNSUBSTANTIATED
Clients who live in facility are afraid of licensee. - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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03/01/2023 10:45 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with licensee Rachelle Whiteside. The purpose of this visit was to deliver the results of a complaint investigation. Prior to initiating the visit, LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask.

During the course of the investigation 2 licensees, 3 clients, 4 staff , 3 day program staff were interviewed. LPA requested the following documents from licensee: related incident reports, Physician’s report, Admission Agreement, IPP for 4 clients, staff list with telephone numbers, client list.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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 3
Control Number 25-AS-20221205134655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: STARLIGHT RESIDENTIAL 2
FACILITY NUMBER: 455002707
VISIT DATE: 03/01/2023
NARRATIVE
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Page 2

Licensee restrained client - UNSUBSTANTIATED

2 of 3 clients stated that licensee Mike Whiteside had restrained a client. 1 of 3 clients stated the licensee never restrains clients.

3 of 4 staff stated they did not know anything about licensee Mike Whiteside restraining a client. 1 of 4 staff stated they heard the licensee had restrained a client but did not witness it.

The licensee Mike Whiteside stated they did not restrain a client, Client 1 (C1) was upset because Client 3 (C3) was sitting on the couch and C1 told C3 to move. C1 ran toward C3 and the licensee got between them.

One day program administrator stated that C1 had not told them anything about being restrained by the licensee. One day program staff stated C1 told them he was arguing with C3. C1 got up and the licensee stopped C1 from getting up, sat C1 on the couch, and held C1’s shoulders. The day program staff did not witness the licensee restraining C1.

Licensee Michelle Whiteside stated C3 was sitting in the living room and C1 went to punch C3. Mike (licensee) got up in the living room and stood between them. Licensee Michelle Whiteside was not present in the facility during this interaction.

It was determined that there was an argument between two clients and licensee Mike Whiteside got between them to prevent further escalation of the situation. Although two clients stated that the licensee had restrained a client, one of the clients who stated this did not witness the licensee restraining the client. One staff said they heard about the client being restrained but did not witness the client being restrained. This allegation is unsubstantiated.

Continued on LIC812-C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20221205134655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: STARLIGHT RESIDENTIAL 2
FACILITY NUMBER: 455002707
VISIT DATE: 03/01/2023
NARRATIVE
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Page 3

Clients who live in facility are afraid of licensee - UNSUBSTANTIATED

2 of 3 clients stated they are not afraid of the licensee. 1 of 3 clients stated they are scared, but not specifically scared of the licensee.

2 of 4 staff stated the licensee has a good relationship with the clients, 2 of 4 staff stated they don’t know what the licensee’s relationship with the clients is like.

The licensee Mike Whiteside stated they have a good relationship with the clients in the home.

This allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to facility licensee Rachelle Whiteside.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3