191290642-12-20-2023-31-AS-NMAN-CZ6PEV-20240104101546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 12/20/2023
Date Signed: 12/20/2023 04:26:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20231214144843

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	CELIA GARCIA		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(323) 697-2248
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 134	DATE:	12/20/2023
		UNANNOUNCED	TIME BEGAN:	03:16 PM
MET WITH:	Brandy Rangel, Assistant Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not refill resident’s medication prescription

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Assistant Administrator Brandy Rangel and explained the reason for the visit.

It was reported that staff did not refill resident's medication prescription. To investigate this allegation on 12/20/2023, between 3:20pm and 3:45pm, staff interviews were initiated. Interviews revealed that the pharmacy informed the facility that that they could not fill the presciption. The pharmacy ran a CURES report and discovered that Resident #1 (R1) had been using mutiple pharmacies and multiple doctors to get narcotic medications. The pharmacy told R1 that their behavior and actions were a red flag and could not dispense any more medication. Between 3:45pm and 4:00pm, LPA reviewed facility records. Records confirmed what staff told LPA.
Based on interviews and records review, there is not sufficient information to support this allegation. Thus, this allegation is UNSUBSTANTIATED at this time. Exit interview conducted and a copy of the report was issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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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