191290642-3-20-2024-31-AS-NMAN-D4TPKE-20240430112302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 03/20/2024
Date Signed: 03/20/2024 11:56:06 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/17/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20231017145002

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: 148	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Brandy Rangel		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff are financially abusing resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to render final findings for the above allegation. LPA met with Assistant Administrator, Brandy Rangel, and explained the reason for the visit.

---Staff are financially abusing resident in care.

It was alleged that facility staff are financially abusing resident(s) in care. During this investigation, on 10/18/23, between 1:00pm and 1:30pm, LPAs Valenzuela and Saucedo conducted interviews with facility staff. Between 1:30pm and 2:15pm, LPAs requested and reviewed facility records including R1’s financial records and P&I Ledgers.

(CONT on LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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 3

Control Number 31-AS-20231017145002

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 03/20/2024

NARRATIVE

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On 10/23/24, at 11:00am, LPM Margaryan and LPA Valenzuela spoke with facility residents and interviewed night shift personnel over the phone. In addition, LPM Margaryan conducted a phone interview with other parties that were managing R1’s finances. On 10/27/24 the Licensing Office requested assistance from the Community Care Investigations Bureau to obtain records from R1’s bank account. Prior to this visit, LPM Margaryan received documents from other parties regarding R1’s missing check.

Staff revealed that R1’s finances were managed by the Public Guardian Office (PGO) and facility had outstanding balance for R1’s rent for the month of February 2023. They contacted the PGO and were informed that the check was cashed. The staff managing residents’ finances had no knowledge of who cashed the check or when. Staff also revealed that residents’ mail, including checks that were sent to the facility, was managed by the front desk assistant. However, when mail is delivered in the late afternoon, the night shift staff sorts and distributes the mail to residents.

Interviews of night shift personnel and additional witnesses revealed that staff #1 (S1) was working the night shift sorting and distributing the mail. S1 knew that the mail addressed to the facility should have been sorted and stored at the front office.

Staff responsible for facility finances revealed that although they knew who had access to the facility mail, they did not conduct an internal investigation to attempt to recover R1’s check. Additional investigations revealed that police were notified and on 06/15/2023 at 6:50am S1 was arrested at the facility.

Based on interviews and record review, there is a sufficient information to support the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No other health and safety hazards were noted during the visit.

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

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20231017145002

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/20/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/25/2024 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights... (a) In addition...residents... have all of the following personal rights: (8) To be free from... financial exploitation. This requirement is not met as evidenced by;	1 2 3 4 5 6 7	The Administrator of the current licensed facility of the same address agreed to provide an in-service training on financial exploitation to staff and send proof by the POC due date.
	8 9 10 11 12 13 14	Based on interviews and record review, R1 was financially exploited by S1 which posed an immediate Health, Safety, or Personal Rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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