198601543-9-17-2025-11-AS-SCIS-DMBVNH-20251010163510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601543
Report Date: 09/16/2025
Date Signed: 09/17/2025 10:19:52 AM

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
08/14/2025 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20250814094516

FACILITY NAME:	LUMIERE VILLA INC		FACILITY NUMBER:	198601543
ADMINISTRATOR:	NOLASCO MARASIGAN		FACILITY TYPE:	735
ADDRESS:	4167 W 168TH STREET		TELEPHONE:	(310) 465-7010
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY:	4	CENSUS: 0	DATE:	09/16/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Meera Gopy, Administrator		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Staff member is coercing resident in care

INVESTIGATION FINDINGS:

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On 9/17/25 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived and spoke to the Administrator, Meera Gopy and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following:

On 8/22/25 LPA Shirley reviewed copies of the following records for C-1: Resident Roster, Identification and Emergency Information, Admission Agreement, Physician’s Report, Individualized Program Plan, and incident report dated, 8/13/25. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-3 (S1 – S3), and Witness – 1 and Witness - 2(W-1 & W-2). LPA Shirley attempted to interview Client – 1 (C1), but LPA was not able to as he is non-verbal.

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250814094516

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: LUMIERE VILLA INC	FACILITY NUMBER: 198601543
	VISIT DATE: 09/16/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff member is coercing resident in care.

It is alleged that staff members were coercing C-1 from leaving this facility. On 8/22/25, LPA Felisa Shirley reviewed the unusual incident report dated 8/13/25. Per the incident report the Administrator, S1 called law enforcement because she felt that the Westside Regional Center (WRC) Representative, (W-1), was acting erratic, and continuously asking C-1, “Do you want to come with us?” Per email from W-1, dated 8/14/25, staff members frequently entered the room causing multiple interruptions during the private conversation with C-1. Upon further review of this email from WRC, W-1 had to intercede when S-1 escalated verbally. LPA Shirley requested a copy of the alleged 911 call from LA County Sheriff Department and has not received a response yet for the requested phone call record.

LPA interviewed staff 1 – staff 3 (S-1 – S-3). Of those interviewed 3 out of 3 denied the allegation. Client 1, (C-1), was not available for interview. Witness -1 (W-1) confirmed the allegation. Witness – 2 (W-2), neither denied nor substantiated the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff member is coercing resident in care,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Administrator, Meera Gopy.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

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