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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320284
Report Date: 06/13/2024
Date Signed: 06/13/2024 04:14:39 PM

Substantiated


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: 2DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Kari BergersonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff mishandled a client's medication.
INVESTIGATION FINDINGS:
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On 06/13/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent 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 interviewed the Director, Nurse, Admission Director, and two (2) clients. 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.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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 8
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: 06/13/2024
NARRATIVE
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Allegation(s):
Staff mishandled a client's medication.

The investigation revealed the following: Regarding the allegation "Staff mishandled a client's medication,” it is being alleged that reports their medication was given incorrectly. It is being alleged that the client has two medications to take and the staff mixed them up. It is being alleged that the medications are to be taken six hours apart but were given at the same time. Record review reveals that Lorazepam is not to be taken within six hours of Valium, also known as Diazepam. Record review reveals that on 05/24/24 Lorazepam and Diazepam was given within six hours of each other. Interview with Staff confirmed that Valium is also known as Diazepam and that the medication on 05/24/24 was administered incorrectly. Regarding the allegation “Staff mishandled a client's medication,” based on record review and interviews, the preponderance of evidence has been met therefore the allegation is Substantiated.



Deficiencies were issued.

An exit interview was conducted and plans of correction developed. A copy of this report and appeals rights was reviewed and left with Spencer.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 8
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: 2DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Kari BergersonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff do not provide adequate food service.
Staff do not have planned activities for a client.
Staff are isolating a client while in care.
Staff denied a client access to the facility.
Staff unlawfully evicted a client.
Staff are making unauthorized medical decisions for a client.
INVESTIGATION FINDINGS:
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On 06/13/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent 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 interviewed the Director, Nurse, Admission Director, and two (2) clients. On 06/06/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPAs 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 8
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: 06/13/2024
NARRATIVE
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Allegation(s):
Staff do not provide adequate food service.

The investigation revealed the following: Regarding the allegation "Staff do not provide adequate food service,” it is being alleged that the food does not meet client #1’s (C1) dietary restrictions. It is being alleged that C1 is borderline diabetic and was served grains and sugars. Also, it is being alleged that moldy and expired food are in the fridge and and other clients threw it out. Lastly, it is being alleged C1 offered to buy food that meets their diet. During the physical plant tour, LPA Cloyd observed the facility to have plenty of perishables in stock and nonperishable in the cabinet and on the kitchen counter. Interview with the Director indicated that the chef will work around clients’ dietary restrictions, clients have the option to make their own meals using the food from the refrigerator, and/or purchase their own outside snacks. Interview with the Chef indicated that she follows dietary restrictions and speak individually with clients, including C1, concerning any restrictions and preferences. Interview with the clients indicated that adequate food service is provided, dietary restrictions are met, and food is thrown out every one – three days, and clients have the option to purchase their own food. Regarding the allegation “Staff do not provide adequate food service,” based on observations 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 have planned activities for a client.


The investigation revealed the following: Regarding the allegation " Staff do not have planned activities for a client,” during the physical plant tour, LPA Cloyd observed an hourly activity schedule on the whiteboard in the dining room for June 6, 2024. Record review revealed that the facility had planned activities throughout the week (05/20/24 – 06/02/24). Interview with the Director indicated that the facility also offers natural activities, art, outside games, and supervised walks for clients who do not attend off-site activities. Client interviews indicated that the facility offer activities and staff engage clients throughout the week.

Continue to LIC9099-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 8
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: 06/13/2024
NARRATIVE
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Regarding the allegation “Staff do not have planned activities for a client,” based on observation, record review, 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 are isolating a client while in care.

The investigation revealed the following: Regarding the allegation " Staff are isolating a client while in care,” it is being alleged that Client #1 (C1) is being isolated and was not allowed to go on 05/26/24 and 05/27/24 beach outings with the other residents. Record review revealed that off-site activities was offered on 05/26/24 only. Interview with the Director indicated C1 was on extended observation for 72 hours as of 05/24/24 around 4:00 PM. Staff and client interviews indicated that new clients are placed on an extended observations before clients are approved for off-site social activities. Record review revealed that the facility has a client manual that indicates that for safety purposes, some clients may be placed on 72 hours extended observation. The client manual was signed by C1. Regarding the allegation “Staff are isolating a client while in care,” based on record review 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 denied a client access to the facility.

The investigation revealed the following: Regarding the allegation "Staff denied a client access to the facility,” it is being alleged that on 05/24/24, Client #1 (C1) had to wait outside and would not be allowed in. Also, it is alleged that C1 paid to be admitted but was told to go to a hotel. Interview with the Director indicated that although the facility expected C1 to arrive at 10:00 AM, C1 arrived at 2:00 PM and was granted access around 4:00 PM.


Continue to LIC9099-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 8
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: 06/13/2024
NARRATIVE
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According to the Director, the Admissions Department encourages all new clients to arrive before Friday(s) 12:00 PM so that the clinical team can properly assess clients and prepare the weekend staff. From 2:00 PM – 4:00 PM, the Director and Floating Shift Supervisor sat outside with the client until the Admission Department completed its internal steps. Staff and client interviews indicated that C1 was granted access to the facility. Regarding the allegation “Staff denied a client access to the facility,” based on 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 unlawfully evicted a client.

The investigation revealed the following: Regarding the allegation " Staff unlawfully evicted a client,” it is being alleged that staff has told Client #1 (C1) to go to a hotel, to leave the facility but C1 would not be considered kicked out. Also, it is alleged that C1 did not receive an eviction notice. Record review revealed that Psychiatric Mobile Response Team (PMRT) recommended hospitalization on 05/28/24. Interview with the Director and Admission Director confirmed that PMRT was called and C1 was hospitalized. Regarding the allegation “Staff unlawfully evicted a client,” based on record review 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: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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: 06/13/2024
NARRATIVE
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Allegation(s):
Staff are making unauthorized medical decisions for a client.

The investigation revealed the following: Regarding the allegation "Staff are making unauthorized medical decisions for a client,” it is being alleged that four mental health representatives came to the facility and staff are forcing them to have residents medicated even though Client #1 (C1) does not want the medicine. Interview with the Director and Admission Director indicated that Psychiatric Mobile Response Team (PMRT) was contacted on 05/28/24. Record review revealed that PMRT assessed client for approximately 1 hour and 10 minutes prior to recommending hospitalization and requesting a transportation team and police. Regarding the allegation “Staff are making unauthorized medical decisions for a client,” 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 and a copy of this report was provided to Primary Therapist Spencer Roesche.

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

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 8
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2024
Section Cited
CCR
80075(b)(5)(B)
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(5) If the client's physician has stated in writing that the client is unable to determine his/her own need ... the licensee shall be permitted to assist the client with self-administration, providing all of the following requirements are met: (B) ... the medication is given according
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The Director will provide evidence of medication training to regina.cloyd@dss.ca.gov by the POC due.
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to the physician's directions. This requirement is not met as evidence by: Record review revealed that Lorazepam is not to be taken within six hours of Valium, also known as Diazepam. On 05/24/24, Lorazepam was taken within six hours of Diazepam.
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 8 of 8