191290642-1-9-2024-31-AS-NMAN-CZTW4F-20240125155728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 01/09/2024
Date Signed: 01/09/2024 04:58:05 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
06/27/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230627082740

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:	01/09/2024
		UNANNOUNCED	TIME BEGAN:	04:05 PM
MET WITH:	Aaron Khordorkovsky, Administrator		TIME COMPLETED:	04:53 PM

ALLEGATION(S):

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Resident was sexually assaulted by another resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela made an unannounced complaint visit to this facility to deliver the findings. LPA Valenzuela met with Administrator Aaron Khordorkovsky and disclosed the purpose of this visit.

A 24-hour visit was conducted by Licensing Program Analyst (LPA) Tihesha Smith on 06/28/2023 at which time LPA Smith conducted an interview with the administrator at 9:50am and conducted a physical plant tour of the facility at around 10:07am.

On 06/27/2023 this case was referred to the Community Care Licensing Investigative Branch (IB). Investigator Laura Garcia continued the investigation by conducting interviews and records review on 06/30/2023 and on 07/03/2023.

Continue on 9099-C

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: 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)

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Control Number 31-AS-20230627082740

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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It was alleged that Resident #1 (R1) was sexually assaulted by Resident #2 (R2). Interviews with the administrator revealed that R1 reported a fall with bruising on 6/16/2023. Administrator interviewed R1 to clarify how the fall was sustained and R1 revealed that their bed broke while having sexual intercourse with R2. Interviews with R1 conducted on 07/03/2023 by IB Investigator revealed that no sexual assault occurred. R1 revealed that they were injured during the consensual sexual act when R1's began tilting and landing on R1's leg, causing a bruise.

Overall, the investigation revealed that R1 denied any type of sexual abuse and indicated that the sexual encounter between them and R2 was consensual. R1 confirmed that at no point during the encounter did they feel threatened or abused. R1 also denied any type of neglect/lack of supervision by facility staff and indicated that they are extremely satisfied with the level of care provided by staff.

Based on interviews and records review, there is insufficient evidence to prove that the alleged violation did occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 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)

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