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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802441
Report Date: 10/14/2021
Date Signed: 10/14/2021 11:47:53 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2021 and conducted by Evaluator Martha Guzman-Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20210824114220
FACILITY NAME:LOVELY COMMUNITY HEALTHCAREFACILITY NUMBER:
565802441
ADMINISTRATOR:TOUME, CILVAFACILITY TYPE:
740
ADDRESS:52 W NORMAN AVENUETELEPHONE:
(805) 852-8770
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 6DATE:
10/14/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cilva ToumeTIME COMPLETED:
11:46 AM
ALLEGATION(S):
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Facility violated residents’ personal rights – Unsubstantiated
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Martha Guzman Chavez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. On 08/26/2021, LPA Guzman Chavez conducted an initial 10-day complaint inspection. On today’s visit, LPA Guzman Chavez met with Administrator Cilva Toume. Entrance interview conducted.
During the initial visit on 08/26/2021, LPA Guzman Chavez conducted a physical plant tour with Administrator Cilva at 4:58pm. Between 5:10pm - 7:38pm, the LPA interviewed residents, Administrator, and staff. On 08/27/2021, LPA Guzman Chavez conducted telephonic interviews with family members of residents between 3:22pm and 4:24pm.
Regarding the allegation, ‘Facility violated residents personal rights,’ the complainant’s concern is residents do not have a choice of bedtime hours. It was further alleged that the Reporting Party (RP) visited the facility on different occasions, and all lights were out in the residence and residents were in bed.
(...Continued on LIC 9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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 2
Control Number 29-AS-20210824114220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LOVELY COMMUNITY HEALTHCARE
FACILITY NUMBER: 565802441
VISIT DATE: 10/14/2021
NARRATIVE
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(...Continued from LIC 9099...)

During the investigation, LPA Guzman Chavez conducted interviews with residents, resident family members, Administrator, and staff. Interviews with residents revealed that they do not know what time they go to sleep, but they know it is close to their bedtime because they are tired. Additionally, residents interviewed were asked about their daily routine and they mentioned that residents start early every day as they all wake up early. According to residents, breakfast is usually ready before 7:00am, lunch is around 11:00am, and dinner is before 5:00pm. Also, there is no set bedtime for residents. Interviews with residents also revealed, that some residents have dinner around 3:30pm, and shortly afterwards go to bed. Interviews with resident family members revealed, the families are aware of residents going to sleep early. Resident family member mentioned that previously, resident was restless, but feels they are getting better rest now, as they are more responsive when they visit. Another family member mentioned that they are aware of resident going to sleep early, and they appreciate that they allow them to rest. In the past few weeks, they have noticed an improvement in resident’s health, and they are more alert during visitation. Family member also said they are not sure what time resident goes to bed, but every time they come visit resident, they are clean and well kept. Resident family member stated, If the resident does not complain about their bedtime, they have no problem with it either. Interviews with facility staff revealed, residents wake up early in the morning every day. When asked about resident’s daily routine, staff said residents are usually awake while they do their morning routine checks. During the morning routine check, staff take residents out to the living room to have breakfast and start their day. When asked about bedtimes, staff interviews revealed, there is no bedtime, residents ask to go to their rooms shortly after having dinner stating they are tired and would like to go to bed. Furthermore, interview with the Administrator revealed, staff accommodate residents by taking them to their rooms early in the day per resident’s request.
Based on the evidence gathered through interviews with residents, resident family members, staff, and Administrator, there is insufficient evidence to support the allegation, ‘Facility violated residents’ personal rights.’ Therefore, this allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of the report will be emailed to Administrator.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2