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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 01/09/2024
Date Signed: 01/09/2024 05:06:12 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
01/08/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240108133454
FACILITY NAME:LEISURE VALE RETIREMENT HOTELFACILITY NUMBER:
191290642
ADMINISTRATOR:CELIA GARCIAFACILITY TYPE:
740
ADDRESS:413 E. CYPRESSTELEPHONE:
(323) 697-2248
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: DATE:
01/09/2024
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Aaron Khordorkovsky, AdministratorTIME COMPLETED:
02:04 PM
ALLEGATION(S):
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Facility is wrongfully evicting resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Admistrator Aaron Khordorkovsky and explained the reason for the visit.

It was reported that facility is wrongfully evicting resident in care. To investigate this allegation on 1/09/2024 at 10:45am, LPA requested Resident #1 (R1's) most up to date medical records and reappraisal. Between 11:00am and 12:00pm, R1's medical records and reappraisals were reviewed. Records revealed that R1 was placed on a 5150 hold due to being gravely disabled and displaying aggressive behavior. In addition, the reappraisal revealed that R1 continues to be be psychotic and to have delusional thoughts. R1 is refusing to take medications. Between 12:00pm and 1:00pm, LPA interviewed the Administrator. Interviews confirm what medical records and reappraisal stated. Per doctor's orders, R1 was being discharged to a Skilled Nursing Facility. R1 is not being evicted, they require a higher level of care that the facility can not provide. Moreover, R1 is not comparable to the other residents in care. Continue on 9099-C


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
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 31-AS-20240108133454
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEISURE VALE RETIREMENT HOTEL
FACILITY NUMBER: 191290642
VISIT DATE: 01/09/2024
NARRATIVE
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Based on interviews and records review there is sufficient information to not verify this allegation. Therefore, this allegation is being UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2