191290642-4-6-2021-28-AS-MVAO-C23MWZ-20210414095910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 04/02/2021
Date Signed: 04/06/2021 10:50:15 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/18/2020 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201218142611

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	POLITA BARNES		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 71	DATE:	04/02/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jesse Loera		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents room does not have a working heater
Staff did not adequately clean resident's room

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another complaint visit for the allegation(s) listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Assistant Administrator, Jesse Loera.

The investigation consisted of the following : interview(s) with Assistant Administrator, Staff #1- Staff #3, and Resident #1 - Resident #9. Assistant administrator and staff interviewed, denied the allegations.
Regarding the allegation that Residents room does not have a working heater : They stated that resident(s) rooms have a unit mounted on the wall that is both an a/c unit and a heater. Staff stated that to their knowledge, all residents have a working heater in their room(s). Staff stated that if a resident's heater isn't working, residents are to notify staff, and it will be repaired or replaced for them.

Regarding the allegation that Staff did not adequately clean resident's room: Staff stated that residents rooms are cleaned on a daily basis, and deep cleaned once per week. They denied that staff did not adequately clean residents rooms.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

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-20201218142611

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 04/02/2021

NARRATIVE

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Residents interviewed stated that they do not have any issues with the heater in their room(s). They stated that they have either wall unit for a/c and heat, or they have been provided with a portable heater. Residents interviewed stated that they were comfortable with the heat provided in their room(s). Residents stated that if something in their room isn't working, they just have to notify staff. Residents stated that staff take care of repairs promptly.

Residents interviewed stated that staff clean their room(s) on a daily basis. They stated that they were satisfied with the frequency and with the adequacy in which their room(s) were cleaned.

Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted via telephone with the Assistant Administrator and a hardcopy was provided via email for signature. Signatures on hardcopy.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

LIC9099 (FAS) - (06/04)

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