191290642-9-18-2023-31-AS-NMAN-D5CV2Z-20240517160357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 09/18/2023
Date Signed: 09/18/2023 05:34:21 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
09/13/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230913140623

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: 131	DATE:	09/18/2023
		UNANNOUNCED	TIME BEGAN:	10:32 AM
MET WITH:	Celia Garcia, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff refuse to transfer resident from their wheelchair

Staff did not appropriately assist resident with toileting

INVESTIGATION FINDINGS:

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

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

It was reported that staff refuse to transfer resident from their wheelchair. To investigate this allegation on 9/18/2023, between 12:40pm and 1:15pm, staff interviews were intiated. Interviews revealed that Resident #1 (R1) does not have or uses a wheelchair. R1 uses a walker to ambulate. Between 10:45am and 12:00pm, facility records were reviewed. Records confirmed what staff told LPA. R1 uses a walker and needs help in transferring in and out of bed. On 9/12/2023, night staff #1 (S1) was busy assisting another resident and called other staff to assist R1 in walking them to the bathroom and making sure that they sat down properly on the toilet seat. R1 wanted S1 to help them, but they could not go, therefore another staff was sent to assist in transferring the resident from their walker to the toilet seat and then back to their bed. LPA attempted to interview R1, but they were not able to recall the events that transpired on the night of 9/12/23.

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: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

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-20230913140623

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: 09/18/2023

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

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 alleged that staff did not appropriately assist resident with toileting. To investigate this allegation on 9/18/2023, between 12:45pm and 1:15pm, staff interviews were initiated. Interviews revealed that R1 does not need help with toileting since they are able to care for their own toileting needs. Nevertheless, R1 does need assistance with transferring from their walker to the toilet seat. Staff assist R1 with transferring only.
Between 10:45am and 12:00pm, facility records were reviewed. Records confirmed what staff told LPA. R1 can take care of the their own toileting needs, but require assistance with transferring.

Based on interviews and records review, there is not sufficient information to support this allegation. Thus, this allegation is deemed 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: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2