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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320284
Report Date: 06/06/2024
Date Signed: 06/06/2024 04:43:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2024 and conducted by Evaluator Regina Cloyd
COMPLAINT CONTROL NUMBER: 11-AS-20240528161544
FACILITY NAME:LIGHTFULLY - SOLFACILITY NUMBER:
198320284
ADMINISTRATOR:MAYEH, ELNAZFACILITY TYPE:
772
ADDRESS:1414 SAN VICENTE BLVDTELEPHONE:
(858) 692-5374
CITY:SANTA MONICASTATE: CAZIP CODE:
90402
CAPACITY:6CENSUS: 4DATE:
06/06/2024
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Kari BergersonTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not properly maintain a client's bathroom.
Staff do not keep the facility free from pests.
Staff mishandled a client's personal belongings.
INVESTIGATION FINDINGS:
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On 06/06/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA met with Director of Clinical Operations Kari Bergerson and explained the purpose of the visit. The investigation consisted of the following: During today’s investigation, LPA toured the physical plant, reviewed records, and interviewed (5) five staff members.

Continue to LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 4
Control Number 11-AS-20240528161544
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LIGHTFULLY - SOL
FACILITY NUMBER: 198320284
VISIT DATE: 06/06/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation " Staff did not properly maintain a client's bathroom,” it is being alleged that the bathroom had feces on the toilet seat and urine on the floor. LPA Cloyd observed all client restrooms and (shared) bathrooms to be clean and sanitary. LPA observed a cleaning crew on the premises around 12:00 PM. Staff interviews indicated that the facility bathrooms are maintained and they have not received complaints concerning its cleanliness. Regarding the allegation “Staff did not properly maintain a client's bathroom,” based on observation and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation(s):

Staff do not keep the facility free from pests.


The investigation revealed the following: Regarding the allegation "Staff do not keep the facility free from pests,” it is being alleged that there are flies in the house and they are never removed. During the physical plant tour, LPA Cloyd observed the facility to be free from flies. Staff interviews indicated that the facility does not have issues with flies. Regarding the allegation “Staff do not keep the facility free from pests,” based on observation and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Continue to LIC9099-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20240528161544
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LIGHTFULLY - SOL
FACILITY NUMBER: 198320284
VISIT DATE: 06/06/2024
NARRATIVE
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Allegation(s):
Staff mishandled a client's personal belongings.

The investigation revealed the following: Regarding the allegation "Staff mishandled a client's personal belongings,” it is being alleged that the staff take residents’ phone and lock up their personal belongings. Residents are always being told they cannot access their stuff when asked. During the physical plant tour, LPA observe client lockers in the staff room. Interview with the Director indicated that items such as keys, laced shoes, cellphones, sharp objects, and money are kept in lockers. From 10:00 PM – 6:00 AM, the facility has a “No Electronics” policy listed in its Client Manual. Staff interviews confirmed that clients are not allowed to have their cellphones during program hours. Record review revealed that the Client Manual has an electronic policy stating, “electronics will be accessible at designated times and prohibited during groups, sessions, and meals (unless approved by the therapist for assignment sharing purposes)”. R1 signed the Client Manual. Regarding the allegation “Staff mishandled a client's personal belongings,” based on interviews and record review, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.


No deficiency was cited for this allegation.

An exit interview was conducted with Director Kari Bergerson and a hard copy of this report was provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4