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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881455
Report Date: 09/15/2026
Date Signed: 09/15/2026 12:31:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/26/2024 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240926124115
FACILITY NAME:LUNA SENIOR LIVINGFACILITY NUMBER:
331881455
ADMINISTRATOR:MAMYAN, NARINEFACILITY TYPE:
740
ADDRESS:1361 E LUNA WAYTELEPHONE:
(818) 568-6812
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:0CENSUS: 0DATE:
09/15/2026
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Andhika Danawaty, CaregiverTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not prevent resident from developing a pressure injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegation. LPA met with Andhika Danawaty, Caregiver, and informed them of the purpose of the LPA’s visit. The Department’s investigation involved interviews with staff and residents and review of records.

On September 26, 2024, Community Care Licensing (The Department) received a complaint report with the following allegation.

It was alleged that staff did not prevent resident from developing a pressure injury while in care. Information received indicated that Resident #1 (R1) was on hospice and developed pressure injuries due to staff neglect.
Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jacob Garber
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
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 18-AS-20240926124115
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LUNA SENIOR LIVING
FACILITY NUMBER: 331881455
VISIT DATE: 09/15/2026
NARRATIVE
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LPA’s records review revealed that R1 was admitted on May 31, 2024, already under hospice care plan and passed away on July 6, 2024. R1’s hospice records dated May 31, 2024, indicated that R1 was assessed for risk of skin breakdown due to disease progression, decreased activity and poor nutritional intake. Hospice records dated June 20, 2024, indicated that R1 developed wound in sacrum area. Wound care records dated June 20, 2024, indicated that R1’s wound started approximately 30 days prior, which was before R1’s admission. R1’s physician’s report indicated that R1 had cognitive condition, history of skin breakdown and behavior issues. LPA conducted review of R1’s wound care report dated June 20, 2024, June 27, 2024, and July 2, 2024. LPA did not observe anything to indicate that R1’s wound was a result of staff neglect.

Based on records review, R1’s pressure injury started prior to R1’s admission to this facility, and the pressure injury was a result of R1’s disease progression. The Department’s investigation did not provide enough information to corroborate the allegation that staff did not prevent resident from developing a pressure injury while in care.

The evidence found during the investigation did not meet the preponderance of evidence standard. Therefore, this allegation is unsubstantiated at this time. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.


An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Jacob Garber
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
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