191290642-2-29-2024-31-AS-NMAN-D36TLM-20240308134947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 02/29/2024
Date Signed: 02/29/2024 05:02:33 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
02/28/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240228115518

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	AARON KHODORKOVSKY		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(323) 697-2248
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 143	DATE:	02/29/2024
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Brandy Rangel, Assistant Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not address an inappropriate sexual interaction between residents

Staff did not give resident medication as prescribed

INVESTIGATION FINDINGS:

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Licening Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Assistant Administrator Brandy Rangel and explained the reason for the visit.

It was reported that staff did not address an inappropiate sexual interaction between residents. It was alleged that Resident #1 (R1) was sexually assaulted with a cane by Resident #2 (R2). To investigate this allegation on 02/29/2024 between 1:00pm and 1:45pm, staff interviews were initiated. Interviews revealed that R1 denied both to the facility staff and to Law Enforcement that they were sexually assaulted by R2. R1 stated that R2 accidently bumped into them with their cane. In addition, R1 told staff that R2 is their friend and that they are not sexually or romantically involved with one another. Between 1:45pm and 2:25pm, LPA reviewed the statements that R1 made to Law Enforcement. The statements made to Law Enforcement confirm was staff had told LPA that there was not any sexual interaction betwen the residents.

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: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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-20240228115518

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: 02/29/2024

NARRATIVE

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Based on interviews and records review, there is not sufficient information to support this allegation. Thus, this allegation is UNSUBSTANTIATED at this time.

It was alleged that Staff did not give resident medication as prescribed. It was reported that R1 did not get their medication one morning. To investigate this allegation between 1:00pm and 1:45pm, staff interviews were initiated. Interviews reveal that R1 has missed their medication more than once. R1 is ambulatory and tends to leave the facility early in the morning before getting there medication. Also, there have been times when R1 refuses to take their medication. Between 2:45pm and 3:15pm, facility records were reviewed. The Medication Administration Record (MAR) was checked. Records confirmed what staff told LPA. R1 has missed medication due to not being present at the facility and not because staff are not giving them their medication. Also, it has been noted on the MAR that at times R1 refuses to take their medication.

Based on interviews and records review, there is not sufficient information to verify this allegation. Therefore, this allegation is 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: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC9099 (FAS) - (06/04)

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