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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320349
Report Date: 12/12/2024
Date Signed: 12/12/2024 11:32:06 AM

Document Has Been Signed on 12/12/2024 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CLEAR BEHAVIORAL HEALTHFACILITY NUMBER:
198320349
ADMINISTRATOR/
DIRECTOR:		LINDSEY RAE ACKERMANFACILITY TYPE:
772
ADDRESS:1208 HIGHVIEW AVETELEPHONE:
(877) 799-1985
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 6CENSUS: 6DATE:
12/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Sarah GhassemyTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 12/12/24, California Department of Social Services (CDSS) Staff conducted a case management - incident visit at the above facility. CDSS Staff met with Director of Operations Sarah Ghassemy and explained the purpose of the visit was to gather information surrounding the client-on-staff sexual alleged incident that occurred on 12/04/2024. On 12/10/24, the regional office received an unusual incident report concerning Client #1 and Staff #2. CDSS Staff collected electronic copies of Client #1's file, Staff #2's file, and facility records. Due to further investigation needed, and analysis of documentation this incident will be continued by the Investigations Branch's Investigator.


An exit interview was conducted and a copy of this report was provided to Director of Operations Sarah Ghassemy.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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