565850233-1-13-2025-29-AS-KHEN-DDESVA-20250130131227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850233
Report Date: 01/13/2025
Date Signed: 01/13/2025 01:20:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
10/18/2024 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20241018150532

FACILITY NAME:	LIGHTFULLY-MOONBEAM		FACILITY NUMBER:	565850233
ADMINISTRATOR:	YVETTE LLANOS		FACILITY TYPE:	772
ADDRESS:	1247 LA PERESA DRIVE		TELEPHONE:	(858) 692-5374
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	6	CENSUS: 4	DATE:	01/13/2025
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Amir Javanmard		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are not able to meet residents' needs in a timely manner.
Staff does not provide residents medication in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation with the purpose of delivering findings for the allegations listed above at 01:10PM. LPA met with Program Manager (PM) Amir Javanmard. Reason for the visit was explained.

During the initial visit on 10/25/2024, LPA reviewed and obtained copies of pertinent documents between 09:40AM – 11:20AM, conducted a brief physical plant tour and health and safety check at 11:20AM, conducted inter rviews with three (3) clients and four (4) staff between 11:25AM – 11:55AM, and discussed allegations with the Director of Clinical Operations Gina Guerrero (DCO) and PM around 12PM.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

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 29-AS-20241018150532

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LIGHTFULLY-MOONBEAM	FACILITY NUMBER: 565850233
	VISIT DATE: 01/13/2025

NARRATIVE

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It was alleged that staff are not able to meet residents’ needs and provide medications in a timely manner. LPA interviewed three (3) out five (5) residents during the initial visit and all residents confirmed their needs, such as showering and eating, are met and medications are administered timely. No concerns noted. Staff interviewed during the initial visit reported that residents’ needs are met timely. One (1) out of four (4) staff interviewed reported that there have been instances in the past where residents do not get their medication for the day due to staff forgetting, but such an incident has not occurred recently.

During the initial visit, one (1) new client was in the process of moving into the facility, making total census during the visit six (6). LPA was unable to review records for the sixth client as no records were pertinent to the investigation. LPA reviewed medication logs from 10/14/2024 – 10/25/2024 for all five (5) clients and observed all medications administered timely to clients. No errors or missed doses were observed. All staff interviewed reported that it can be difficult at times to administer morning medications because residents have difficulty waking up and leaving their rooms to take their medications. Medications are only administered in the medication room which is on a different floor than resident rooms. Residents refuse their morning medications at times, but then take them in the afternoon after they are awake and out of their rooms. LPA observed medication refusals appropriately documented on medication logs. Per regulation, residents have the right to refuse medications and staff cannot forcefully administer. Based on interviews and record review, the Department does not have sufficient evidence to corroborate the allegations. Although the allegations may be valid, at this time there is insufficient evidence to support the allegations or that a violation occurred, therefore, the allegations “Staff are not able to meet residents' needs in a timely manner” and “Staff does not provide residents medication in a timely manner” are deemed UNSUBSTANTIATED at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

LIC9099 (FAS) - (06/04)

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