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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850233
Report Date: 11/13/2024
Date Signed: 11/14/2024 09:14:26 AM

Unsubstantiated


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
10/13/2023 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20231013104106
FACILITY NAME:LIGHTFULLY-MOONBEAMFACILITY NUMBER:
565850233
ADMINISTRATOR:YVETTE LLANOSFACILITY TYPE:
772
ADDRESS:1247 LA PERESA DRIVETELEPHONE:
(858) 692-5374
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:6CENSUS: 6DATE:
11/13/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Gina Guerrero, Director of Clinical Operations &
Amir Javanmard, Program Manager
TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Residents are being neglected while in care
Facility is operating out of ratio
Staff spoke inappropriately to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver investigation finding. Upon arrival LPA met with staff. LPA was introduced to the new Administrator/Director of Clinical Operations Gina Guerrero and Program Manger Amir Javanmard. A physical plant tour was conducted with Mr. Javamard. The reason for the visit was discussed with Ms. Guerrero.

Following is a summary of the allegations and investigation finding:

On 10/13/2023, Community Care Licensing Division received the above allegations. On 10/19/2023, Licensing Program Analyst (LPA) Zabel Chochian conducted the initial complaint visit and met with Administrator Yvette Llanos and staff. Between 12:30pm-1:30p.m., allegations were discussed with Administrator and pertinent documents were requested and reviewed. Between 1:45pm-3:30pm, LPA conducted interviews with all five (5) clients and two (2) staff. Additional staff interviews were conducted on 09/24/2024, 11/04/2024, 11/12/2024, and 11/13/2024 (continue to LIC9099c).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
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 29-AS-20231013104106
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: LIGHTFULLY-MOONBEAM
FACILITY NUMBER: 565850233
VISIT DATE: 11/13/2024
NARRATIVE
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Regarding allegations “Residents are being neglected while in care” and “staff spoke inappropriately to residents” – Information was received that residents in the home are not provided support
It was reported that a resident was visibly triggered due to inappropriate discussion held by staff during a group session and staff did not provide any support. Interview conducted with staff revealed that residents are all treated with respect and attended to accordingly. Staff denied allegations. Staff interviewed reported that they have not neglected or spoke inappropriately to any resident; staff reported they have not witnessed any resident be neglected or spoken to inappropriately. Staff reported that all residents are provided the support needed. LPA conducted interview with five out five residents in the home and all residents reported no mistreatment by any staff. All residents reported that they feel safe and are treated well by all staff. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Residents are being neglected while in care” and “staff spoke inappropriately to residents” are deemed UNSUBSTANTIATED at this time.

Regarding allegation “Facility is operating out of ratio” – Information was reported that the facility is out of resident to staff ratio; the home is three floors and often with only one Client Care Technician (CCT) staff. Also, it was report that when a resident needs support and staff ask for help, they are not given any support. According to reporting party there is no way for CCT staff to monitor all residents within eyesight if they are on different floors. LPA conducted interview with CCT staff, and it was reported that staff to resident ratio is one staff to three residents. CCT staff confirmed that when asked for assistance the management or facility therapist would provide assistant to CCT staff. Administrator and LPA reviewed the facility staffing schedule for the first two weeks of 10/2023 (10/1-10/15). CCT staffing schedule shows one CCT staff on each shift from 7am-7pm; 6pm-6am and 7pm-7am. Administrator explained that between the hours of 7am-6pm they have a CCT staff, a group, and a primary therapist on duty; from 7pm to 7am two CCT staff are scheduled when facility census is four or more residents. Furthermore, Administrator stated that if any staff need assistance management and therapist staff assist when needed to meet the facility staffing ratio. According to administrator the facility staffing ratio is maintained accordingly and no issues or concerns were reported. LPA interviewed five out five residents during the initial visit did not express any staffing issue and all residents confirmed their needs are met. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Facility is operating out of ratio” is deemed UNSUBSTANTIATED at this time.
Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC9099 (FAS) - (06/04)
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