191290642-8-1-2023-31-AS-MVAO-D4EQKM-20240417121434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 08/01/2023
Date Signed: 08/01/2023 01:25:06 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.ASC, 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
07/25/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230725164837

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: 120	DATE:	08/01/2023
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Nilda Mercado - Front office manager		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff refused to accept resident back from hospital.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegation. LPA met with and explained the reason for the visit.

LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:00 AM and interviewed staff and resident between 10:12 AM to 12:00 PM. It was alleged that the facility refused to accept Resident #1 (R1) back at the facility due to hearsay reason. LPA's observation during visit at 9:35 AM revealed that R1 was back at the facility. LPA's interview with staff revealed that R1 was never refused to return to the facility nor issued an eviction letter because the facility is not evicting R1. Further interview with staff also revealed that there was a confusion because R1 expressed desire to leave the facility on R1's own but then came back to the facility on R1's own accord. Based on the information gathered during this visit. The allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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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