191290642-11-28-2023-31-AS-NMAN-CZEUNH-20240112144359

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 11/28/2023
Date Signed: 11/28/2023 03:50:07 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
11/20/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20231120201724

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: 126	DATE:	11/28/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Aaron Khodorkovsky, Interim Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff is retaliating against resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced complaint visit for the above noted allegations. LPA met with Administrator Aaron Khodorkovsky and explained the purpose of the visit.

It was reported that staff is retailating against resident in care for filing complaints to Licensing To investigate this allegation on 11/28/2023, between 12:00pm and 1:00pm, staff interviews were initiated. Interviews revealed that staff is not retaliating against Resident #1 (R1) for filing complaints. Staff state that they know that residents have personal rights and that they can file complaints. The facility is trying their best to provide care and supervision to R1. Staff go out of their way to assist R1 with their activities of daily living.

Based on interviews there is not sufficient information to verifty this allegation. Thus, this allegation is UNSUBSTANTIATED. 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: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

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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