191290642-3-5-2024-28-AS-MVAO-D49MWS-20240412095850

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 03/05/2024
Date Signed: 03/05/2024 02:52:03 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
04/07/2023 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230407144208

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: 134	DATE:	03/05/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Brandy Rangel		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff speak inappropriately to residents
Staff do not meet resident's incontinence needs
Staff do not properly supervise resident
Staff divulged resident's confidential information to residents
Facility not maintained clean and sanitary
Staff did not ensure that hazardous item is stored inaccessible to residents in care
Staff do not assist resident with managing behavior

INVESTIGATION FINDINGS:

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On 03/05/24, at 8:50am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by assistant administator Brandy Rangel. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, interviews and deliver findings for this complaint.

On 04/12/2023, LPA Agard initiated the complaint investigation. On 03/05/24 at 8:50am, 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 9:40am. During the tour, thirteen (13) residents and nine (9) 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: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 28-AS-20230407144208

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: 03/05/2024

NARRATIVE

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Regarding the allegation: Staff speak inappropriately to residents. It is being alleged that staff/caregivers speak inappropriately to residents by yelling, being verbally abusive, including teasing and taunting. LPA conducted interviews with eleven (11) out of thirteen (13) residents who informed the LPA that they have not experienced or observed any facility staff to be verbally abusive to them or any other residents. In addition, the LPA asked the assistant administrator if any staff have been reprimanded for yelling or being verbally abusive to any of the residents or to each other staff. The assistant administrator was able to confirm that no one has been reprimanded for such behavior. LPA was able to review three (3) staff files who were mentioned in the above allegation(s) and did not observe any reprimands. LPA also interviewed nine (9) staff who confirmed that they have not witnessed any staff yelling or being abusive to residents and/or co-workers. Therefore, based on the LPA's interviews, observations, and record reviews the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff do not meet resident's incontinence needs. It is being alleged that residents are in soiled diapers for prolonged periods of time. LPA conducted interviews with eleven (11) out of thirteen (13) residents who informed the LPA that their incontinence needs are met. The residents were able to confirm that their diapers are changed first thing in the morning, after lunch and before going to sleep. LPA also verified with the assistant administrator how many caregivers per shift are available for incontinence needs. The assistant administrator stated that there are five (5) caregivers in the AM and four (4) on the PM shift. The caregiver supervisor also verified that if the resident needs an extra change or help with incontinence, they can use the signal system to request a caregiver to their room for assistance. LPA interviewed nine (9) staff who confirmed that they have not witnessed any resident in solid diapers while in care. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff do not properly supervise resident. It is being alleged that residents are in diapers in the dining area and dance inappropriately in the patio area. LPA conducted interviews with eleven (11) out of thirteen (13) residents who informed the LPA that they have not seen any residents in the dining area wearing only diapers and dancing inappropriately in the patio area. LPA also interviewed nine (9) staff who confirmed that they have not witnessed any residents sitting in the dining area wearing only diapers and dancing inappropriately in the patio area. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

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: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230407144208

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: 03/05/2024

NARRATIVE

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Regarding the allegation: Staff divulged resident's confidential information to residents. It is being alleged that a staff yelled out the medical conditions of a resident. LPA conducted interviews with eleven (11) out of thirteen (13) residents and the residents were able to confirm that they have not heard anyone yelling out the medical conditions of other residents. LPA also interviewed nine (9) staff confirming that they have not heard anyone disclosing any information about residents. Therefore, based on the LPA's interviews the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Facility not maintained clean and sanitary. It is being alleged that a resident’s room had a bad odor. During the physical tour, LPA did not observe the facility to not be clean or unsanitary. LPA was also able to access some of the resident’s rooms and none of the rooms had a bad odor. During the physical tour, LPA also observed housekeepers cleaning the facility. LPA also verified with the assistant administrator how many housekeepers per shift are available for cleaning the facility. The assistant administrator confirmed that there are four (4) housekeepers that clean the facility not including the maintenance staff or caregivers. LPA conducted interviews with eleven (11) out of thirteen (13) residents confirming that there is daily cleaning of the facility. LPA also interviewed nine (9) staff confirming that they do observe cleaning every day. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Staff did not ensure that hazardous item is stored inaccessible to residents in care. It is being alleged that there were knives in the resident’s rooms. During the physical tour, LPA selected random rooms to tour and there were household items in all the rooms. LPA conducted interviews with eleven (11) out of thirteen (13) residents confirming that different things can be kept in their room. The assistant administration confirmed that their room is their privacy and if it does not disturb or harm each other different items are authorized. Six (6) out of nine (9) staff were able to confirm that different items especially household items can be kept in the resident rooms as long as it used appropriately. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

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: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230407144208

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: 03/05/2024

NARRATIVE

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Regarding the allegation: Staff do not assist resident with managing behavior. It is being alleged that a resident was speeding through the facility using their motorized wheelchair and knocked over a medication cart. LPA conducted interviews with eleven (11) out of thirteen (13) residents who informed the LPA that they have not seen any residents speeding through the facility using their motorized wheelchair and knocking over medication carts. The residents did state there are residents in wheelchairs but not speeding inside the facility. LPA also interviewed nine (9) staff who confirmed that this behavior would be unacceptable unless it was a mistake from a resident bumping into a medication cart. LPA was also able to tour the medication room and looked at the medication carts. The different medication carts cannot be easily knocked over due to a motorized wheelchair or any type of wheelchair. The medication carts are heavy duty equipped with a ton of medication inside each cart. Therefore, based on the LPA's interviews and observations the above allegation(s) above is unsubstantiated at this time.

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

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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