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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 01:38:32 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, 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
PUBLIC
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: 3DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Sara Ghassemw-Director of OperationsTIME COMPLETED:
01:38 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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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: Program Director Interview(D#1), Client’s interviews (C#1-C#4) and Witness interview(C#1). LPA obtained and reviewed the following documents: Client’s roster, Personnel roster, (C#1-C#4) Identification and Emergency Information, (C#1-C#4) Admissions agreements, (C#1-C#4) Physicians Report for Residential Care Facilities for the Elderly, (C#1-C#4) Needs and Services Plan, (C#1-C#4) Medication Administration Record (MAR) for the month of August 2023, (C#1-C#4) Admissions Agreement, copies of facility menu for the month of august 2024 and a health and safety check of the perishable and non-perishable food.

Evaluation Report continues LIC 9099-C

Unsubstantiated
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 4
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 did not provide resident with adequate food service.


The details of the complaint alleged that facility staff did not accommodate client’s food preference.



During the records review, LPA Iniguez reviewed copies of the facility menu from 7/28-8/3, 8/4-8/10, 8/11-8/17, and 8/18-8/24. LPA observed that the facility's weekly menus included various meals with calorie counts, and they met at least 1/3 of the servings recommended in the USDA Basic Food Group Plan. In addition, LPA reviewed (C#1)’s Admissions Agreement, there is nothing written on (C#1)’s dislikes about aversion to seafood.

During a tour of the facility, LPA observed that there was enough perishable and non-perishable food, plus snacks, for clients in care.

During an Interview with the Program Director (D#1), she stated that the facility offers food choices if the clients prefer something other than what they are serving that day. Also, (D#1) was unaware of (C#1) 's aversion to seafood.

During an interview with Client 1 (C#1), they stated that the facility gave them fish to eat, but they have an aversion to seafood. However, (C#1) stated that the facility still forced them to eat it.

During interviews with Clients (C#2-C#4), (3) out of (3) clients stated that the facility accommodates their food preferences, and the facility offers food choices in case they don't like what they are having that day. Also, (3) out of (3) clients state that they have yet to be served something they don't want to eat.

During interviews with staff (S#1-S#2), (2) out (2) staff stated that the facility accommodated client's food preferences, the facility has a weekly menu, and the clients have the option to request something off the menu in case they don't like what the facility is serving that day. Also, (2) out of (2) facility staff state that they have never served something a client does not like.

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 4
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 allow resident to access outdoor areas.

The details of the complaint alleged that facility staff did not allow client to access front area of facility.



During a physical tour of the facility, LPA Iniguez observed a chair in the front area available for clients to use.

During an Interview with the Administrator (D#1), she stated that the facility does not prohibit clients from using the front area. All clients are welcome to use that area, but they must always be accompanied by facility staff. Also, it is contingent upon the staff ratio and the wishes of most of the clients.

During an interview with client 1 (C#1), they stated that the facility staff did not allow them to sit at the front of the “house.”

During interviews with Clients (C#2-C#4), (3) out of (3) clients stated that they are allowed to sit at the front of the facility always with staff, and they have never heard a staff told them not to sit at the front.

During interviews with staff (S#1-S#2), (2) out (2) staff stated that the clients are allowed to sit at the front of the facility always if a staff member is with them, and they said that they have never told a client not to sit at the front.

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: 3 of 4
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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During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.


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: 4 of 4