Facility Evaluation Report

On 05/26/26 at 9:20am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced case management visit to Rostar Home I INC. LPA was met by Thana Theng, Administrator. The purpose of the visit was to gather facility files and get information about an incident that occurred on 05/20/26 involving Client #1.

On 05/21/26, the facility reported an incident concerning Client #1 that occurred on 05/20/26; the client was hit by a car while walking home. According to the incident report, the police and an ambulance were called, and the client was taken to the hospital where it was discovered that the client’s right leg had a tibia plateau fracture and surgery was needed. Thana Theng stated that they received a phone call from the police stating an accident had occurred involving C1 and they were taken to Harbor UCLA emergency room. Thana Theng stated that they did not have a police report because according to the police who left a message on their phone, it was a minor injury, and no police report was needed. The department requested that they provide Community Care Licensing Division a copy of the discharge paperwork once the client has left the hospital.

· ID and Emergency Information (Dated: 10/23/2024 )

· Physician Report for Community Care Facilities LIC 602 (Dated: 06/16/2025)

· Current Medications (Dated: 04/01/2026-04/30/2026)