<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320284
Report Date: 01/30/2025
Date Signed: 01/30/2025 10:44:49 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/26/2024 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241126095446
FACILITY NAME:LIGHTFULLY - SOLFACILITY NUMBER:
198320284
ADMINISTRATOR:KATHERINE BERGERSONFACILITY TYPE:
772
ADDRESS:1414 SAN VICENTE BLVDTELEPHONE:
(858) 692-5374
CITY:SANTA MONICASTATE: CAZIP CODE:
90402
CAPACITY:6CENSUS: 4DATE:
01/30/2025
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Katherine BergersonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility wrongfully evicted resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/04/24, at 10:00am, Community Care Licensing Division (CCLD) Staff conducted an initial complaint visit to the facility and was greeted by Kari Bergerson, Director of Clinical Operations, and Rica Distor, Program Manager. CCLD explained the purpose of this visit is to gather information about the complaint, gather facility files, and deliver findings for the allegation mentioned above.

The investigation consisted of the following: An initial complaint visit was completed by (CCLD) staff on 12/04/2024. A subsequent visit was completed by (CCLD) staff on 01/30/2025. The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S2) and client (C1). Client Roster Current and Past (Dated: No Date) Staff Roster (Dated: No Date), Admission Agreement (Dated: 11/04/2024), Discharge Summary (Dated: 11/05/2024), Special Situation Note (Dated: 11/05/2024), Biopsychosocial Assessment Adult (Dated: 11/05/2024), Contact Note (Dated: 11/05/2024), List of Referrals (Dated: 11/05/2024) and Contact Note Family (Dated: 11/05/2024) were obtained from the facility.

Complaint Investigation Report Continued On LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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 11-AS-20241126095446
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: LIGHTFULLY - SOL
FACILITY NUMBER: 198320284
VISIT DATE: 01/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following: Allegation- Facility wrongfully evicted resident in care.

The details of the complaint alleged that the client (C1) was admitted to the facility on 11/04/2024 and evicted on 11/05/2024. It is alleged that the facility wrongfully evicted the client on short notice and the potential risks of such an immediate discharge, given the circumstances, was unethical. On 12/04/24, from 10:00am-1:00pm, the department interviewed staff (S1-S2) and client (C1) regarding the allegation. 2 of 2 staff denied the allegation that the Facility wrongfully evicted resident in care. All staff (S1-S2) interviewed stated that the facility does not accept clients who have Restricted Health Care Conditions and that need a higher level of care. They stated that the client had a Foley Catheter installed and did not report it to the facility during Pre-Appraisal. They stated this was the reason for the discharge.

The department interviewed client (C1) about the allegation and 1 of 1 client that were interviewed corroborated the allegation that Facility wrongfully evicted resident in care. The client stated that they did not have the Foley Catheter permanently installed until the day after the eviction, 11/06/2024. C1 stated that they would go to the ER and have their bladder drained with the Foley Catheter, then request that it be removed. C1 also stated that they could manage trips to the hospital without the assistance of the facility to have C1s bladder drained, and the device removed. C1 stated that the facility failed to give C1 enough notice and that C1s family was out of state and that C1 was alone with very little recourse.

The department reviewed the Biopsychosocial Assessment Adult (Dated: 11/05/2024), Admission Agreement (Dated: 11/04/2024), Discharge Summary (Dated: 11/05/2024), and Special Situation Note (Dated: 11/05/2024).

The department observed that the facility did not have a physician’s report stating that the client had a permanent Foley Catheter installed when C1 returned from the hospital. The department also observed that the facility did not have a reappraisal and modification to the Needs and Services plan for C1 which determined that the client’s needs could not be met by the facility, and the client has been given an opportunity to relocate, rather than a same day discharge.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation Facility wrongfully evicted resident in care, is found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (2) are being cited on the attached LIC 9099D.

Note: *Citations not cleared by the due date will have a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. If the facility plans to appeal, the plan of corrections must still be completed by the due date.

An exit interview was conducted, appeal rights were printed and discussed with Kari Bergerson, Director of Clinical Operations, and a hard copy of this Complaint Investigation Report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20241126095446
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: LIGHTFULLY - SOL
FACILITY NUMBER: 198320284
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2025
Section Cited
CCR
81068.5(a)(5)(A)
1
2
3
4
5
6
7
81068.5(a)(5)(A) Eviction Procedures(a) The licensee shall be permitted to evict a client with 30 days' written notice for any of the following reasons: (5) Inability to meet the client's needs. (A) A Needs and Services Plan modification has must have been performed, as specified in Section 81068.3, which determined that the client's needs cannot be met by the facility and the client has been given an opportunity to relocate as specified in Section 81068.3(f)(3). This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee/Administrator will review regulations 81068.5(a)(5)(A) regarding Eviction Procedures to ensure that the regulations are followed when serving a discharge notice/eviction notice, and submit a signed statement that it has been read and understood to LPA Perry Scott by POC due date 02/10/2025 to perry.scott@dss.ca.gov
8
9
10
11
12
13
14
Based on interviews conducted and records reviewed, the facility failed to do a reappraisal and modification to the Needs and Services plan and give C1 a reasonable opportunity to relocate.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3