191290642-9-25-2023-31-AS-NMAN-D4WSM4-20240503135918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 09/25/2023
Date Signed: 09/25/2023 05:30:55 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
09/20/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230920114004

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: 130	DATE:	09/25/2023
		UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Celia Garcia, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff made inappropriate comments about resident in their presence

Staff did not assist resident with their doctor appointment

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Liceinsing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Administrator Celia Garcia. The purpose of the visit was discussed.

It was reported that staff made inappropriate comments about resident in their presence. To investigate this allegation on 9/25/2023, between 11:30am and 12:00pm, staff interviews were initiated. Interviews revealed that staff did not make any inappropriate comments about Resident #1 (R1). Staff do not recall having any conversations about R1 during the month of March. Moreover, two staff stated that it is possible that they were dicussing something that they saw on T.V. and R1 thought they were referring to them.

Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

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: 09/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

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 2

Control Number 31-AS-20230920114004

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: 09/25/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

It was alleged that staff did not assist resident with their doctor appointment. To investigate this allegation on 9/25/2023, between 11:30 and 12:00pm, staff interviews were initiated. Interviews revealed that R1 did not go to their scheduled monthly doctor appointment because they got upset with the front office. Furthermore, between 12:30pm and 1:30pm, facility records were reviewed. Records revealed that per admission agreement third party services can be arranged by notifying the administrator or assistant administrator. R1 did not notify them. R1 notified the front office manager to make arrangements for them.

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

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2