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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 12:13:41 PM

Substantiated


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
12/27/2022 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20221227134125
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:
11:45 AM
MET WITH:Rachelle Whiteside - licenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff threatened clients - SUBSTANTIATED
INVESTIGATION FINDINGS:
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03/01/2023 11:45 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
Substantiated
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 6
Control Number 25-AS-20221227134125
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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Staff threatened clients - SUBSTANTIATED

2 of 2 clients stated they had been threatened by Licensee Mike Whiteside.

3 of 4 staff stated they had not heard about staff threatening the clients. 1 staff stated they heard the licensee with C1 during an interaction at the facility. C1 called the licensee a derogatory name, to which the licensee replied “Why don’t you show me the (derogatory name) I am.”

It was determined that 2 clients stated they had been threatened by the licensee. One staff member witnessed the licensee threatening one of the clients. This allegation is substantiated.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview was conducted and the report was provided to licensee Rachelle Whiteside.

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on 1569.49(f) H&S. Failure to correct the deficiencies may also result in civil penalties.

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 6
Control Number 25-AS-20221227134125
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2023
Section Cited
CCR
80072(a)(3)
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80072 (a)(3) Personal Rights - (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from … humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. This requirement is not met as evidenced by:
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Licensee Rachelle Whiteside agrees to provide personal rights training for all direct care and administrative staff particularly concerning treating clients with dignity and respect. Licensee will schedule the training and provide LPA with the training content and signed staff attendance sheet as the POC.
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Based on interviews, it was determined that 2 clients stated they had been threatened by the licensee. One staff member witnessed the licensee threatening 1 of the 2 clients. This poses a potential health and safety risk to clients in care.
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The proof of correction is to be received by LPA Knight by 03/22/2023.
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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.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
12/27/2022 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20221227134125

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:
11:45 AM
MET WITH:TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Items in client room were tampered with - UNSUBSTANTIATED
Staff do not allow residents to use electricity at the care home - UNSUBSTANTIATED
Facility does not have sufficient staff to meet the clients' needs - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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03/01/2023 11:45 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, gloves.
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: 4 of 6
Control Number 25-AS-20221227134125
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
Items in client room were tampered with

1 client stated that items had been tampered with in their room.

3 of 4 staff interviewed stated they did not know anything about a client’s items being tampered with in their room. 1 of 4 staff stated that C1’s remote and USB cords were given to another client to use while C1 was not at home.

The licensee Mike Whiteside stated they had not heard anything about a client having items in their room tampered with.

It was determined that although C3 was using C1's remote control and USB cords in C1's absence this does not constitute tampering. The items were returned to the client. This allegation is unsubstantiated.

Staff do not allow residents to use electricity at the care home.

I client stated they were not allowed to plug in their coffee maker in the facility kitchen.

2 of 4 staff stated staff were not preventing clients from using the electricity in the home. 1 staff stated there was one situation when the electricity went off on one side of house and someone had to come and fix it. 1 staff stated they heard that C1 was not allowed to use their coffee maker a couple of times but did not witness this.

The licensee Mike Whiteside stated the facility had a power outage and there were some outlets that were not working in the kitchen. The licensee had the griddle set up and C1 wanted to plug in their Keurig to make coffee. Due to the power malfunctioning C1 was asked to wait a few minutes before plugging in the Keurig. The electricity malfunction in the facility’s kitchen was repaired the next day.

It was determined that the facility was having some electrical issues in the kitchen and a client was asked to wait to use their coffee maker but was not prevented from using their coffee maker. 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: 5 of 6
Control Number 25-AS-20221227134125
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

Facility does not have sufficient staff to meet the clients' needs.

3 of 4 staff stated there are enough staff to provide care for the clients. 1 staff stated there are not enough staff on the weekends.

The licensee Mike Whiteside stated they definitely have enough staff to meet the needs of the clients in the home.

It was determined that the facility has enough staff to meet client’s needs. 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: 6 of 6