331881581-10-9-2026-18-AS-APEZ-DYTSPC-20261013140255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881581
Report Date: 10/09/2026
Date Signed: 10/09/2026 01:59:30 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
10/08/2026 and conducted by Evaluator Seo Jeon

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20261008112023

FACILITY NAME:	LUNA SENIOR LIVING		FACILITY NUMBER:	331881581
ADMINISTRATOR:	HOVSEPIAN, SAHAK		FACILITY TYPE:	740
ADDRESS:	1361 E LUNA WAY		TELEPHONE:	(818) 641-9222
CITY:	PALM SPRINGS	STATE: CA	ZIP CODE:	92262
CAPACITY:	6	CENSUS: 5	DATE:	10/09/2026
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Danawaty Andhika, Caregiver		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Due to staff neglect/lack of supervision, resident was verbally abused

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to investigate the above allegation. LPA met with Danawaty Andhika, 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 October 8, 2026, Community Care Licensing (The Department) received a complaint report with the following allegation.

It was alleged that due to staff neglect/lack of supervision, resident was verbally abused. Information received indicated that Resident #2 (R2) called Resident #1 (R1) an inappropriate language. LPA conducted an interview with R1, who confirmed that R2 used an inappropriate language during a conversation at the dining table in the facility about one (1) week ago. LPA conducted an interview with R2, who confirmed using the inappropriate language toward R1. R2 explained that R1 talked about certain staff members' ethnic backgrounds that offended R2 as well as another resident. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jacob Garber
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2026

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 18-AS-20261008112023

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: 331881581
	VISIT DATE: 10/09/2026

NARRATIVE

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R1 previously said things about the staff members that offended R2 multiple times. LPA conducted an interview with Resident #3 (R2), who confirmed R2’s statement.

LPA conducted interviews with two (2) staff members, both of whom confirmed the statements from the residents interviewed. Both staff members confirmed that they were present during the alleged verbal incident between R1 and R2. LPA obtained the staff schedule and confirmed their staff coverage. Both staff members stated that they redirected both R1 and R2, following their facility policy.

LPA conducted a tour of the facility. The facility is a small home with six (6) capacity that has its kitchen and living room in the middle of it. LPA observed that staff members were always in the center of the facility and could always provide care and supervision.

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.

***LPA left the facility at 12:00 noon and returned at 1:30 PM.

SUPERVISORS NAME: Jacob Garber
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2026

LIC9099 (FAS) - (06/04)

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