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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320413
Report Date: 10/03/2024
Date Signed: 10/03/2024 12:25:35 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, 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
08/20/2024 and conducted by Evaluator Alfonso Iniguez
COMPLAINT CONTROL NUMBER: 11-AS-20240820104410
FACILITY NAME:CLEAR BEHAVIORAL HEALTHFACILITY NUMBER:
198320413
ADMINISTRATOR:LINDSEY RAE ACKERMANFACILITY TYPE:
772
ADDRESS:18616 MANHATTAN PLTELEPHONE:
(877) 799-1985
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY:6CENSUS: DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Sara Ghassemw-Director of OperationsTIME COMPLETED:
12:21 PM
ALLEGATION(S):
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Staff imposed restrictions on resident’s telephone calls.
Staff did not accord resident privacy during telephone calls.
INVESTIGATION FINDINGS:
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On 10/3/24 LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Sara Ghassemw-Director of Operations. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Witness interview(C#1) and Program Director Interview(D#1). LPA obtained and reviewed the following documents: LIC 802 related to this complaint, Title 22 Personal Rights and PIN 21-48-ASC.

Evaluation Report continues LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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 5
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
08/20/2024 and conducted by Evaluator Alfonso Iniguez
COMPLAINT CONTROL NUMBER: 11-AS-20240820104410

FACILITY NAME:CLEAR BEHAVIORAL HEALTHFACILITY NUMBER:
198320413
ADMINISTRATOR:LINDSEY RAE ACKERMANFACILITY TYPE:
772
ADDRESS:18616 MANHATTAN PLTELEPHONE:
(877) 799-1985
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY:6CENSUS: DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Sara Ghassemw-Director of OperationsTIME COMPLETED:
12:21 PM
ALLEGATION(S):
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Staff did not provide resident with adequate food service.
Staff did not allow resident to access outdoor areas.
INVESTIGATION FINDINGS:
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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240820104410
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: CLEAR BEHAVIORAL HEALTH
FACILITY NUMBER: 198320413
VISIT DATE: 10/03/2024
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff imposed restrictions on resident’s telephone calls.


The details of the complaint alleged that facility staff-imposed restrictions on Client’s telephone calls.

During the records review, LPA Iniguez observed the notes taken by CCIB specialist in the body of the LIC 802, CCIB Analyst could hear a door opening and closing during the call, and (C#1) frequently spoke to the staff in the room to ask questions about the facility address and the staff could be heard responding. CCIB Analyst heard another person (possibly the staff) advise (C#1) that they had to end the call. In addition, LPA Iniguez reviewed the PIN 21-48-ASC Resident’s Rights to visitors, Telephone Calls and Personal Mail. It is written that “POAs typically do not address issues concerning visitation, telephone calls, or personal mail and therefore, agents are not authorized to restrict these rights.”

Moreover, LPA Iniguez reviewed (C#1)’s Physician’s Report LIC 602 dated 8/6/24, it is marked that (C#1) is not confused, able to follow instructions and able to communicate their needs, also, (C#1) is able to do all their ADL’s without staff assistance.

During a telephone interview with Witness 1 (C#1), LPA Iniguez noted the following: On 8/20/24, Licensing Program Analyst (LPA) Alfonso Iniguez contacted (C#1) by telephone to gather more information regarding the complaint allegations. (C#1) stated that the facility staff allows them to make two 15-minute phone calls per day. (C#1) also mentioned that if they reach the phone call limit, they are not allowed to make more phone calls during the day.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240820104410
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: CLEAR BEHAVIORAL HEALTH
FACILITY NUMBER: 198320413
VISIT DATE: 10/03/2024
NARRATIVE
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Allegation: Staff did not accord resident privacy during telephone calls.
The details of the complaint alleged that facility staff did not accord client’s privacy during telephone calls.

During the records review, LPA Iniguez observed the notes taken by CCIB specialist in the body of the LIC 802, CCIB Analyst could hear a door opening and closing during the call, and (C#1) frequently spoke to the staff in the room to ask questions about the facility address and the staff could be heard responding. CCIB Analyst heard another person (possibly the staff) advise (C#1) that they had to end the call.

During a telephone interview with Witness 1 (C#1), LPA Iniguez noted the following: On 8/20/24, Licensing Program Analyst (LPA) Alfonso Iniguez contacted (C#1) by telephone to gather more information regarding complaint allegations. During the call, LPA Iniguez heard another person in the background telling (C#1) to end the call. LPA asked (C#1) who the person in the background was, and (C#1) stated that it was a facility staff member telling them their phone call time was up. (C#1) said they are never alone whenever they make a phone call; there’s always a facility staff next to them. LPA informed (C#1) that he had gathered enough information regarding the complaint allegations.


During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D.

An exit interview was conducted, and a copy of the Complaint Report was given to Sara Ghassemw-Director of Operations.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20240820104410
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: CLEAR BEHAVIORAL HEALTH
FACILITY NUMBER: 198320413
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2024
Section Cited
CCR
81072(a)(19)
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81072 Personal Rights
(a) Each client shall have personal rights which include, but are not limited to, the following: (19) To have access to telephones in order to make and receive confidential calls, provided that such calls do not infringe upon the rights of other clients and do not restrict availability of the telephone during emergencies.

This requirement was not met as evidence by:


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Licensee will ensure clients have access to confidential calls at all times. As plan of correction licensee will re-trained facility staff about the clients personal rights to received and make confidential calls.
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Based on a review of records and interviews, the facility staff failed to ensure (C#1) did not have the access to received confidential calls
This poses a potential health and safety risk to all residents in care.
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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: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5