191290642-1-30-2024-31-AS-NMAN-D53NLW-20240508103413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 01/30/2024
Date Signed: 01/30/2024 05:08:23 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
01/25/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240125153008

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	AARON KHODORKOVSKY		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(323) 697-2248
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 126	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Aaron Khodorkovsky, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff member(s) sexually abused resident(s) in care.

INVESTIGATION FINDINGS:

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Licensing Program Analystt (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Administrator Aaron Khodorkovsky and explained the purpose of the visit.

It was reported that staff member(s) sexually abused resident(s) in care. To investigate this allegation on 1/30/2024, between 11:00am and 11:45am, staff interviews were initiated. Interviews revealed that there are no male care-givers working at the facility. Staff deny sexually abusing any residents in care. Moreover, Resident #1 (R1) has a history of making false allegations towards family, friends, and staff. Staff also told LPA that Resident #2 (R2) has a history of confusion and forgetfulness. In addition, R2 had reported to staff that Resident #3 (R3) had sexually assaulted them on 1/25/2024. R2 did not report to staff that an employee from the facility had sexually abused them. Furthermore, on 1/25/2024, law enforcement came to the facility and interviewed both R2 and R3. R2 reported to the police officers that R3 touched the back of their neck for 3 seconds and then placed their soft male organ on their back. R3 was also interviewed and admitted that they gave a massage on the neck for 3 seconds to R2, because they had pain. R3 denies

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: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20240125153008

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: 01/30/2024

NARRATIVE

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touching R2 with their private part. In addition, R3 denies any having any romantic relationship or physical attraction to R2.

Between 3:00pm and 4:00pm, facility records were reviewed. Records revealed that both R1 and R2 experience confusion according to their medical reports. LIC 500 was reviewed by LPA and confirmed that there are no male caregivers working at the facility.

Based on interviews and records review there is not sufficient information to verify this allegation. Thus, 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: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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