191290642-4-19-2023-28-AS-MVAO-CZYUEJ-20240130143113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 04/19/2023
Date Signed: 04/19/2023 03:19:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
02/23/2023 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230223145614

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: 94	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Celia Garcia		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Wrongful eviction.

INVESTIGATION FINDINGS:

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On 03/14/2023 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegation. LPA Agard met with Celia Garcia, Administrator and explained the purpose of this visit was to deliver findings for this complaint.

The investigation consisted of the following: LPA toured the physical plant. LPA conducted interviews and record review. LPA requested the following records: 1) staff roster, 2) resident roster, 3) physician report for R1 and 4) Needs and Services Plan. All records were received at the time of initial visit.

Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: 818-421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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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Control Number 28-AS-20230223145614

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 04/19/2023

NARRATIVE

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The investigation revealed the following…Regarding the allegation: Wrongful eviction, “it’s being alleged the facility declined a resident returning to the facility, leaving them homeless.” LPA interviewed 4 out of 37 staff in total. 0 out of 4 confirmed the allegation. S1 states, “It’s not that we didn’t allow R1 back. They refused to come back and requested a refund.” LPA Agard interviewed 2 witnesses. 1 out of 2 confirmed the allegation. W1 states, the allegation is true. W2 states, they observed R1 refusing to return to the facility. During interviews with residents, LPA interviewed 9 out of 94 residents in total. 1 out of 9 confirmed the allegation. R2-R9 were unable to identify a resident that was wrongly evicted. R1 states, they were not provided with the proper eviction notification despite having no desire to return to the facility. LPA was able to verify, R1 has been relocated and is currently housed.

Based on LPA’s interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: 818-421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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