191290642-8-24-2023-31-AS-NMAN-D4ZRND-20240506131007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 08/24/2023
Date Signed: 08/24/2023 04:18:03 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
08/22/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230822084142

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: 124	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Celia Garcia, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are retaliating against resident

Unqualified staff providing care to resident

Staff are not meeting resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced complaint investigtion visit for the above noted allegations. LPA met with Administrator Celia Garcia. The purpose of the viist was explained.

It was reported that staff are retaliating against resident. To investigate this allegation on, 8/24/2023 at 11:09am, LPA conducted a physical plant tour. At 11:45am, LPA requested copies of facility documents relevant to the investigation. Between 12:00pm and 12:30pm, LPA initiated staff interviews. Interviews revealed that Resident #1 (R1) is mentally disturbed and thinks that staff are trying to poison them. Staff deny retaliating against R1 and simply try not to engage with them. Between 12:30pm and 2:00pm, LPA reviewed facility records. Records revealed that R1 is psychologically impaired. In addition,per facility records, R1 has a long history of making unsubstantiated accussations against staff.
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: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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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Control Number 31-AS-20230822084142

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: 08/24/2023

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 unqualified staff are providing care to resident. To investigate this allegation, between 12:00pm and 12:30pm, LPA initiated staff interviews. Staff interviews revealed that staff are qualified and finger print cleared. R1 does not like the staff and refuses to be assisted. Between 12:30pm and 2:00pm, LPA reviewed facility records. Records confirmed what staff told LPA.

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

It was reported that staff are not meeting residents needs. To investigate this allegation, between 12:00pm and 12:30pm, LPA initiated staff interviews. Staff interviews revealed that staff do assist R1 with their activities of daily living, but that R1 many times refuses help from staff. R1 says they do not want a particular staff to help them or to be in their room. Staff try their best to accommodate to R1's needs and requests. R1 is incontinent and their diaper is frequently changed throughout the day.

Based on interviews there is not sufficient information to support 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: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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