331881581-9-29-2026-18-AS-APEZ-DYGTVQ-20261002150419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881581
Report Date: 09/29/2026
Date Signed: 09/29/2026 11:31:29 AM

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
09/25/2026 and conducted by Evaluator Seo Jeon

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20260925074913

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:	09/29/2026
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Danawaty Andhika, Caregiver		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff did not seek timely medical attention for a resident

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 September 25, 2026, Community Care Licensing (The Department) received a complaint report with the following allegation. It was alleged that staff did not seek timely medical attention for a resident. Information received indicated that Resident #1 (R1) fell on September 21, 2026, but Staff #1 (S1) refused to call 911 and get medical attention for R1.

LPA conducted an interview with R1. R1 stated that they fell in their room trying to touch an oxygen machine that belonged to a roommate. R1 did not state why they tried to touch the roommate’s oxygen machine. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jacob Garber
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

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-20260925074913

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: 09/29/2026

NARRATIVE

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R1 called for help, and S1 came into the room. R1 told S1 to call 911, but S1 refused to do so by stating that S1 could be in trouble for calling 911. R1 ultimately called 911 by themselves.

LPA conducted an interview with S1, who denied refusing to call 911 when R1 fell in the room. S1 stated that S1 and a resident went to R1’s room when they heard R1 calling for help. S1 found R1 on the floor and asked if they were OK. S1 told R1 that R1 needed to go to a hospital, but R1 refused to go to a hospital. R1 stated that they were fine and did not need to see a doctor. After helping R1 get back on the bed, S1 asked R1 again to go to a hospital. R1 again refused to go to a hospital, stating that they were fine. S1 added that R1 was an independent resident managing their own medication and schedule their own appointments. LPA conducted an interview with Resident #2 (R2) who went to R1’s room with S1 during R1’s fall incident. R2 confirmed S1’s statement regarding R1’s fall incident.

Due to conflicting information from the parties involved, 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: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

LIC9099 (FAS) - (06/04)

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