<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 09/07/2023
Date Signed: 09/07/2023 05:36:44 PM

Substantiated


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
09/01/2023 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20230901145531
FACILITY NAME:LEISURE VALE RETIREMENT HOTELFACILITY NUMBER:
191290642
ADMINISTRATOR:CELIA GARCIAFACILITY TYPE:
740
ADDRESS:413 E. CYPRESSTELEPHONE:
(323) 697-2248
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 131DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Celia Garcia, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are failing to assist resident in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rosaura Valenzuela and Licensing Program Manager (LPM) Naira Margaryan conducted and unannounced visit for the above noted allegations. LPA and LPA met with Administrator Celia Garcia. The purpose of the visit was discussed.

It was reported that staff are failing to assist resident in a timely manner. To investigate this allegation on 9/07/2023 between 10:10am and 11:00am staff interviews were initiated. Interviews revealed that on 9/1/2023, three caregivers called out and only two caregivers were present that day. Between 11:30am and 11:50am, Resident # 1 was interviewed. Interviews revealed staff take too long to provide assistance. On the night of 9/06/2023, R1 had to wait eight hours to receive pain medication. LPA asked R1 to pull call light and it took half an hour for staff to show up. Between 2:30pm and 3:00pm ten percent of residents were interviewed. Interviews confirmed what R1 told LPA and LPM. Residents stated that indeed staff take too long to provide assistance. Based on interviews and observation this allegation is substantiated.
Exit interview and a copy of the report was issued.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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-20230901145531
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/2023
Section Cited
CCR
87411(a)(a)
1
2
3
4
5
6
7
87411 Personnel Requirements-(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents needs...

This requirement was not met as evidenced by:(
1
2
3
4
5
6
7
Licensee/ Administrator vill review facility population and review how many personnel are needed to provide the necessary care and supervision to residents. Also, before close of bussiness day on 9/8/2023, Licensee/Administrator will submit in writing to licensing what their hiring process will be.
8
9
10
11
12
13
14
Based on observation, and interviews insufficient number of personnel was affecting timely care and supervision of the residents.

This poses an immediate health and safety 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 MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2