191290642-2-12-2024-28-AS-EMIR-D2VQ6K-20240228105340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 02/12/2024
Date Signed: 02/12/2024 02:10:17 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
04/06/2023 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230406085216

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: 142	DATE:	02/12/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Brandy Rangel		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff did not safeguard resident's belongings.
Facility was not properly maintained.

INVESTIGATION FINDINGS:

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On 02/12/24, at 9:50am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Nilda Mercado-Business Manager. LPA disclosed the purpose of the visitt. LPA explained the purpose of this visit was to gather information, interviews and deliver findings for this complaint.

On 04/11/2023, LPA Agard initiated the complaint investigation. On 02/12/24 at 9:50am, LPA Saucedo asked for the census, resident, and staff roster. The Assistant Administrator, Brandy Rangel met with LPA Saucedo to conduct the physical tour at 10:15am. During the tour, twelve (12) residents and four (4) staff were interviewed.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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 28-AS-20230406085216

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: 02/12/2024

NARRATIVE

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Regarding the allegation: Facility staff did not safeguard resident's belongings. It is being alleged that the resident's belongings were safe in the closet of Room # 39 as the room was being used as facility storage. At some point, the facility changed directors and the resident's belongings were thrown out and a new resident moved into the room. It is also being alleged that the facility never contacted the RP to tell them when it was safe for them to remove the resident's belongings in between COVID lockdowns and RP was waiting for the above facility to tell them know when it was safe to collect their mother-in-law's belongings from the closet. LPA was able to receive documentation from the Client Personal Property and Valuables that on 05-06-2022, all belongings except for two (2) bags of clothing signed by the RP were left for donation. Resident #`1 (R1) left the facility on 05-03-2022 and was transferred to another facility by the family because of change of care/behavior. LPA was able to interview nine (9) out of twelve (12) residents that have confirmed that they are aware of their belongings and the belongings policy on the Admission and Rental Agreement. LPA obtained a copy of the Admission and Rental Agreement. LPA was also able to interview four (4) staff that confirmed the belongings policy and theft and loss of any belongings. Therefore, based on the LPA's interviews, observations, and record reviews the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Facility was not properly maintained. It is being alleged that there is still mold in Room # 39 since the winter of 2022-2023 was extremely rainy and the mold that was discovered in winter 2020 was due to outside water seeping into the wall. (The wall is adjacent to the courtyard outside.) It is also being alleged that the rain gutters were not properly draining the water away from the building during the time of 2005-2020. In addition, the mold was discovered because of a strange odor in the room. LPA interviewed the resident that currently resides in the room. That current resident said they have no issues in that room. When it rained there was no leakage or drainage of water. The resident also says there is no odor. LPA was able to do a walk-through in room #39. LPA did not observe any outside water seeping into the wall and/or the gutters not properly draining the water. There was no observation of water damage and/or leakage in the room. In addition, the LPA did not observe any odor in the room. LPA was also able to

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230406085216

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: 02/12/2024

NARRATIVE

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interview the two (2) previous residents that recently moved out of room #39. Both residents did not have any issues in room #39. Both residents were moved from room #39 because of health and mobility issues to a closer room of the entrance of the facility. LPA was able to obtain documents where it is documented that resident #1 (R1) was not ventilating room. It is documented that the windows needed to be opened for ventilation. A damp-rid moisture tablet was placed in the room at the time but the tablet remained dry with no sign of moisture. LPA was able to interview nine (9) out of twelve (12) residents that have confirmed that they have no issues with maintenance, and/or odors in their rooms. LPA was also able to interview four (4) staff that confirmed if there is any maintenance issues the front desk is available to provide help along with any other staff. Therefore, based on the LPA's interviews, observations, and record reviews the above allegation(s) above is unsubstantiated at this time.

An exit interview was conducted, no citations were issued for the two (2) above allegations, and a copy of this report was given to the administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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