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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881581
Report Date: 05/18/2026
Date Signed: 05/18/2026 12:02:02 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
05/13/2026 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20260513161756
FACILITY NAME:LUNA SENIOR LIVINGFACILITY NUMBER:
331881581
ADMINISTRATOR:HOVSEPIAN, SAHAKFACILITY TYPE:
740
ADDRESS:1361 E LUNA WAYTELEPHONE:
(818) 641-9222
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:6CENSUS: 5DATE:
05/18/2026
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Richard Souhuwat, CaregiverTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff did not assist resident with self-administered medication
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 Richard Souhuwat, 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 May 13, 2026, Community Care Licensing (The Department), received a complaint report with the following allegation.

It was alleged that staff did not assist resident with self-administered medication. Information received indicated that staff are not dispensing medication to Resident #1 (R1). LPA’s records review revealed that R1 was admitted on April 30, 2026 and R1 was their own responsible person. R1 was on various prescription medications for R1’s physical and mental condition.

Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
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-20260513161756
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: 05/18/2026
NARRATIVE
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LPA obtained and reviewed R1’s medication records. LPA did not find any evidence of missing or mis-managed medication for R1. LPA conducted interviews with four (4) residents, all of whom denied staff missing medication dispense. LPA conducted interviews with two (2) staff members, both of whom denied missing medication dispense to any residents in care. LPA conducted an interview with R1 who stated that R1 did not recognize the medications staff had dispensed. R1 acknowledged that staff have dispensed medications.

Based on interviews conducted and records review, the Department’s investigation did not provide enough information to corroborate the allegation that staff did not assist resident with self-administered medication. This allegation is unsubstantiated.

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: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2